HIM Inpatient Facility Coding Auditor

Job Summary

The Coding Auditor/Educator is fully competent to independently code the most complex inpatient and/or outpatient service types. Responsible for auditing coding accuracy and providing detailed feedback. Responsible for training new and existing employees. Provides educational feedback to coding department, clinical staff, and other departments as needed. Investigates and responds to coding related questions and denials.

Minimum Job Qualifications

• Licensure or other certifications: Certified Coding Specialist (CCS) required. Certified Professional Medical Auditor (CPMA), Certified Evaluation and Management Coder (CEMC) or other Nationally recognized healthcare auditing certification required at hire, or required to obtain within six (6) months of hire.

• Educational Requirements: Associate Degree in Health Information Technology or related Healthcare field accepted or a minimum of seven (7) years of hospital based coding/auditing/chart review experience in lieu of Associates Degree.

• Minimum Experience: Minimum combined five (5) years of hospital based coding/auditing/chart review experience to include complex CPT surgical coding and advanced ICD-10-CM and PCS coding. Knowledge of anatomy, pathophysiology, and pharmacology. Minimum one (1) year of progressive experience in auditing and educating.

• Other:

Preferred Job Qualifications

• Preferred Licensure or other certifications:

• Preferred Educational Requirements:

• Preferred Experience: Experience in Teaching facilities and/or trauma facilities.

• Other:

Job Specific and Unique Knowledge, Skills and Abilities

• Must pass an advanced coder competency exam with a minimum score of 95% demonstrating proficiency in inpatient and/or outpatient coding of all service types

• Advanced knowledge of anatomy & physiology, disease processes, medical terminology, pharmacology, and surgical procedures/techniques

• Ability to multitask, prioritize, and manage time efficiently

• Must possess a high level of accuracy and attention to detail

• Proficient use of electronic health records (Epic) and encoder systems (3M)

• Proficient in the use of Microsoft Word, Excel, and PowerPoint including the ability to create reports and graphs to report quality and productivity etc.

• Ability to work independently as a remote employee while remaining actively engaged and supportive of the coding team as a whole

• Advanced written and verbal communication skills

• Advanced knowledge of Coding Resources and demonstrated proficiency in using the appropriate resources

• Advanced knowledge of billing requirements and the ability to resolve the most complex edits

• Ability to audit and validate the accuracy of ICD-10-CM-PCS and CPT codes, DRGs, and APCs

• Ability to mentor and to provide constructive feedback

Essential Tasks and Responsibilities

• Reviews daily Audit work queue assignments and determines the validity of coding by auditing the documentation, coding, and DRG Grouper/APC assignments of each claim.

• Audits each claim according to the coding Guidelines and reimbursement reporting requirements unique to the individual payer.

• Utilizes the appropriate resources and references to justify the correct codes.

• Enters the correct Coding Flags to indicate agreement or disagreement with coding along with detailed comments.

• Discusses findings with coders and escalates to Coding Manager as necessary.

• Identifies documentation deficiencies that contribute to coding errors and escalates to Coding Manager.

• Identifies opportunities to capture Hierarchical Condition Category codes.

• Identifies opportunities to increase Severity of Illness and Risk of Mortality.

• Establish a strong working relationship with Clinical Documentation Improvement to ensure that reimbursement and quality measures are optimized.

• Provides education to physicians related to documentation necessary to correctly abstract and code patient accounts.

• Provides coding related education to other departments as needed.

• Must be able to represent coding in meetings.

• Identifies trends in coding errors and provides pertinent education and training to coding staff.

• Organizes work to ensure that accuracy rates and coder education are current and identifies obstacles to fulfilling responsibilities.

• Collaborates with Coding Management to improve future coding compliance and achieve optimal reimbursement.

• Must maintain coding certification and attend in-service training as required.

• Attends and actively participates in huddles/meetings/committees as required and appropriate.