Clinical Coding Auditor

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🕒 May 1

🤠 Texas – Remote

🤠 Texas – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔎 Auditor

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11 - 50 employees

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📋 Description

• Validates accuracy of assigned ICD-10-CM and PCS codes and DRG grouping • Validates accuracy of assigned HCPCS, CPT-4 and APC grouping secondary diagnoses and procedures. • Validates the assignment of medically necessity narrative diagnoses as required for specific inpatient medical coverage policies including communication with clinical and/or physician. • Assesses the use and quality of coding queries; reports non-compliance with regulatory and/or department standards. • Monitors coder trends and patterns for education opportunities and/or physician and clinical documentation improvement needs. • Maintains DRG change accuracy of 95%. • Supports CCDI department as Coding Reimbursement & Audit team as Subject Matter Experts (SME) in ICD-10-CM and PCS reporting. • Utilizes departmental audit databases and/or software accurately to ensure audit data is robust and accurate to relay coded data accuracy • Prepares detailed reports by use of excel, excel pivot tables and/or other software as provided; continuously improves on trend identification and capture for optimal reporting • Provides ad hoc and/or additional data to support identification and feedback of opportunities to leadership • Identifies and reports opportunities for process improvement • Captures meeting minutes, follow ups and action plans as required according to audit scope. • Recommends refinement and implementation of methods and procedures used to for coder and physician education and training; creates and shares tips and audit team education to support department collaboration and efficiency • Provides adequate data to facilitate the identification of development of actions • Updates and develops team policies and procedures to optimize processes; recommends practices to maintain standards for correct coding • Consistently meets team KPI goals to support department and system revenue and quality targets. • Responds to changes in workload/volumes with team and/or lead communicates when to ensure coverage adjusts for optimal coverage volumes • Verifies, researches and/or and review codes, charges and reimbursement on patient accounts and denials or for service lines. • Completes productivity tracking daily; responds and initiates Analyst to Analyst discussions to team ensure decisions are collaborative, consistent and accurate. • Resolves ITS issues impacting work by collaborative communication with team, vendor, informaticist and/or IT as required. • Maintains frequent and regular contact with manager and seeks consultation and guidance when appropriate. • Participates in personal annual performance evaluation, providing opportunity for growth and development. • Participates in committee work and cross functional teams as determined by department leadership • Consistently abides by the Standards of Ethical Coding as set by AHIMA and adheres to Official Coding Guidelines; reviews and applies the directives published in the AHA Coding Clinic and CPT Assistant publication and other approved resources. • Maintains certification with CE credits. Pursues knowledge and participation in HFMA, AAPC and AHIMA organizations. • Maintains knowledge of regulatory requirements, payer coverage determinations; demonstrates initiative in identifying areas requiring further research. • Completes of all department and system hospital required training and education according to schedule; maintains all required certification(s) and continuing education requirements. • Meets audit, project and task deadlines. • Serves as a subject matter expert in expert in areas of documentation, ICD-10-CM and PCS coding with proficiency in CPT-4, HCPCS and modifier assignment.

🎯 Requirements

• Bachelor's Degree Health Information or related field Preferred • Associate's Degree Health Information or related field Required • H.S. Diploma or Equivalent 5 Years Years of acute care and/or relevant experience may be substituted in lieu of degree Required • 5 Years Acute care inpatient or CPT surgical level coding Required • 1 Year Performing coding and documentation audits Preferred • RHIA - Registered Health Information Administrator 12 Months Required • RHIT - Registered Health Information Technician 12 Months Required • CCS - Certified Coding Specialist 12 Months Required • COC - Certified Outpatient Coder 12 Months Required • Thorough knowledge of ICD 10-CM, PCS and CPT. • Expert in coding convention/automated encoder (knowledge management of NCCI/OCE billing edits). • Practiced in APC and DRG methodologies and regulatory/payer requirements associated with coding. • Ability to interpret and apply coding and regulatory policy to coding practice and record review process. • Must demonstrate efficient time management and organizational skills

🏖️ Benefits

• Health insurance • Professional development • Occasional travel for education/meetings