Coding Quality Auditor

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🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $40 - $63 / hour

⏰ Full Time

🟠 Senior

🔴 Lead

🔎 Auditor

👻 Ghost score 0%

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City of Hope

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

🧬 Biotechnology

🔬 Science

💰 $5.4M Grant - City of Hope on 2024-05

Healthcare • Biotechnology • Science

City of Hope is a nonprofit, NCI-designated comprehensive cancer center and research hospital near Los Angeles that provides patient care, conducts translational biomedical research, and offers education and clinical trials across a national network. It focuses on cancer, diabetes, and other life‑threatening diseases, combining clinical services, laboratory science, training and community outreach to develop new treatments and support patients and families.

📋 Description

• Conduct routine, targeted, pre-bill, and retrospective coding audits • Evaluate coding accuracy, DRG assignment accuracy, abstraction quality, coding compliance, reimbursement integrity, and adherence to coding guidelines, regulations, payer requirements, and organizational standards • Review inpatient encounters to validate diagnosis assignment, procedure assignment, abstracting accuracy, reimbursement classifications, and data integrity • Evaluate coding policies, query practices, and regulatory requirements; identify coding opportunities, risks, and compliance concerns • Perform independent validation reviews of complex diagnosis coding, procedure coding, MS-DRG and APR-DRG assignments, quality reporting elements, reimbursement classifications, and abstracted data • Monitor coding compliance risk areas, Coding Clinic updates, CMS guidance, payer audit findings, OIG Work Plan priorities, RAC-targeted services, denial trends, and emerging regulatory requirements • Provide recommendations supporting regulatory readiness and coding excellence • Complete assigned work within productivity and turnaround expectations supporting candidate-for-bill, DNFB, revenue cycle, and organizational goals • Conduct routine and focused audits of coding staff activities • Prepare audit findings, coding quality reports, scorecards, and recommendations • Monitor and trend coder-specific quality findings to identify opportunities for coaching, competency development, coding education, remediation, and performance improvement • Collaborate with Coding leadership, Inpatient Coders, CDI, Quality, Revenue Cycle, Compliance, and Physician Advisor teams

🎯 Requirements

• Graduate of an accredited Health Information Management (HIM), Health Information Technology (HIT), Healthcare Administration, Nursing, or related healthcare program (Associate's degree or higher); or high school diploma, GED, or equivalent, and completion of anatomy and physiology coursework • Seven (7) years of acute care inpatient coding experience within a hospital, academic medical center, cancer center, or integrated healthcare system environment • Demonstrated experience independently assigning ICD-10-CM and ICD-10-PCS codes for inpatient encounters • Demonstrated experience assigning MS-DRGs, APR-DRGs, and other applicable reimbursement classifications • Experience conducting coding audits, coding validation reviews, coding quality reviews, coding compliance reviews, or coding education activities • Experience evaluating coding accuracy, DRG assignment accuracy, coding compliance, abstracting quality, reimbursement integrity, and coding consistency • Experience applying Official Coding Guidelines, Coding Clinic guidance, CMS regulations, payer requirements, and organizational coding standards • Experience identifying coding trends, coding risks, compliance concerns, denial opportunities, or reimbursement issues through coding review activities • Experience providing feedback, education, coaching, or competency support related to coding quality and coding compliance

🏖️ Benefits

• Comprehensive benefits • Equal opportunity employment

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