Senior Health Information Management Inpatient Coding Auditor

October 29

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Prisma Health

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Healthcare Insurance

Prisma Health is a comprehensive health care provider offering a wide range of medical services to ensure individuals achieve their healthiest state. With numerous locations, advanced technology, and expert specialists, Prisma Health provides accessible and convenient care. Services include primary care, specialized heart, cancer, women's, and children's health, as well as same-day and telehealth options. Prisma Health emphasizes community outreach and education to support overall health and wellness.

10,000+ employees

⚕️ Healthcare Insurance

📋 Description

• Responsible for leading coding teams, coder training, work que management, performing prebill and second-level coding reviews utilizing auditing software and documents findings to improve CC/MCC capture, Risk Variable capture, HAC/PSI, HCC and Quality Indicator validation. • Uses knowledge of coding and compliance guidelines to identify potential documentation, coding and reimbursement issues and report these to coding leadership. • Employ critical thinking skills to alert coding leadership to any trends identified in their reviews and to make suggestions for continual process improvement. • Reviews and responds to inpatient denials as needed. • Performs Inpatient coding by assigning ICD-CM and ICD-PCS codes as well as DRG assignment. • Conducts review and audit of discharged inpatient records (prebill and retrospective reviews) to validate the coding/DRG assignment according to official coding guidelines as supported by the clinical documentation in the record. • Monitors work queues daily to identify, prioritize and assign accounts that need to be coded based on department-specific guidelines and within designated timelines in coordination with leadership. • Mentors and trains coders on application of correct ICD-CD and ICD PCS guidelines. • Coordinates and identifies provider documentation queries for the Clinical Documentation Integrity team to send to clinical providers. • Identifies coding and documentation opportunities following established guidelines when existing documentation is unclear or ambiguous following American Health Information (AHIMA) guidelines and established policy. • Maintains working knowledge of Centers for Medicare & Medicaid Services (CMS) regulations and applicable carrier local medical review policies. • Consults, provides professional expertise to and collaborates with clinical documentation specialists on coding and documentation practices and standards. • Collaborates with Coding and CDI to develop and maintain coding curriculum and training materials. • Assists with and develops educational programs for coding staff, clinical documentation staff and medical staff to including yearly coding/DRG updates. • Applies ICD and ICD-PCS codes including major traumas, and Neonatal Intensive Care Unit (NICU) records based on review of clinical documentation. • Verifies assignment of DRGs, MCC/CCs, Hospital Acquired Conditions (HACs) and Patient Safety Indicators (PSIs) that most appropriately reflect documentation of the occurrence of events, severity of illness, and resources utilized during the inpatient encounter and in compliance with department policies and procedures. • Codes inpatient records periodically based on review of clinical documentation. • Identifies and assists management with the resolution of coding issues, process improvement and system testing for HIM applications. • Interacts with other departments to resolve coding issues and assists with coding and clinical validation denials. • Participates in on site, remote and/or external training workshops and training. • Attends and participates in CDI-Coding Task Force and other collaborative training and education with CDI, PFS, Specialty areas and Quality. • Performs other duties as assigned.

🎯 Requirements

• Associate degree or Coding Certificate through approved American Health Information Management (AHIMA) or other coding certification program. • Four (4) years of experience in in-patient coding and abstracting with healthcare billing process in acute care setting. • Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), Certified Coding Specialist (CCS), Certified Inpatient Coder (CIC) or other approved coding credential. • Knowledge of electronic medical records and 3M or Encoder System. • Knowledge of medical terminology and basic anatomy and physiology, pathophysiology, and pharmacology with the ability to apply this knowledge to the coding process. • Knowledge of MS DRG prospective payment system and severity systems. • Knowledge of clinical documentation Improvement principles, quality indicators, formal and informal coding audit process. • Ability to work effectively, independently and manage multiple demands consistently. • Proficient computer skills (spreadsheets and database).

🏖️ Benefits

• Inspire health. • Serve with compassion. • Be the difference.