Senior Health Information Management Inpatient Coding Auditor

🔥 2 hours ago

🌴 South Carolina – Remote

🌴 South Carolina – Remote

⏰ Full Time

🟠 Senior

🔎 Auditor

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 12%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Prisma Health

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

⚕️ Healthcare Insurance

Healthcare • 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.

📋 Description

• Lead coding teams • Train and mentor coders on correct ICD-CM and ICD-PCS guideline application • Manage work queues daily, prioritizing and assigning inpatient accounts for coding within designated timelines • Conduct prebill and retrospective audits of discharged inpatient records to validate coding and DRG assignments • Document audit findings to improve CC/MCC capture, risk variable capture, HAC/PSI, HCC, and quality indicator validation • Identify documentation, coding, reimbursement, and coding compliance issues and report trends to coding leadership • Coordinate provider documentation queries for the Clinical Documentation Integrity team • Consult and collaborate with clinical documentation specialists on coding and documentation practices • Develop and maintain coding curriculum and training materials • Develop educational programs for coding, clinical documentation, and medical staff, including yearly coding/DRG updates • Assign ICD and ICD-PCS codes and DRGs for inpatient records, including major traumas and NICU records • Verify DRGs, MCCs/CCs, HACs, and PSIs; select principal diagnoses and assign POA indicators and risk-adjustment diagnoses • Review and respond to inpatient denials and assist with coding and clinical validation denials • Assist management with coding issue resolution, process improvement, and HIM application system testing • Participate in CDI-Coding Task Force and collaborative training with CDI, PFS, specialty areas, and Quality • Perform other duties as assigned

🎯 Requirements

• Associate degree or Coding Certificate through an approved American Health Information Management (AHIMA) or other coding certification program • Four (4) years of experience in inpatient coding and abstracting with healthcare billing process in an acute care setting • Required credential: 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, basic anatomy and physiology, pathophysiology, and pharmacology, with ability to apply this knowledge to coding • Knowledge of MS DRG prospective payment system and severity systems • Knowledge of clinical documentation improvement principles, quality indicators, and formal and informal coding audit processes • Ability to work effectively and independently and manage multiple demands consistently • Proficient computer skills, including spreadsheets and databases • Ability to apply broad guidelines to specific coding situations independently, using discretion and significant analytical ability

🏖️ Benefits

• Full-time employment • Day shift • Remote work indicated in the job title • Participation in on-site, remote and/or external training workshops and training