Lead Coding Services Auditor

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Job Summary:

The Lead Coding Services Auditor is responsible for conducting prebill and retrospective reviews to include, but not limited to, focused reviews on identified opportunities, mortality, PSI (patient safety indicators) and coder focused audits. Reviews include full DRG validation, review of assigned ICD-10-CM/PCS, POA indicator(s), validation of all abstracting elements, review for query opportunities affecting DRG, severity of illness, and/or risk of mortality scores. Auditor will use Vizient risk adjustment tools to identify potential coding opportunities during chart reviews. All audits performed ensure compliance with current coding guidelines and regulatory standards. The Lead Coding Services Auditor will use critical thinking skills and knowledge of coding/compliance guidelines to identify potential documentation, coding and reimbursement issues and report these to the leadership.
The Lead Coding Services Auditor serves as a mentor for the auditing team providing expert level expertise and feedback to the auditing and leadership team. The Lead Coding Auditor will represent the auditing team in meetings within and outside the department on subject matter within the owning area. The Lead Coding Services Auditor will create and maintain detailed data logs and trend and produce data in a meaningful executive style format for presentation.

Core Responsibilities and Essential Functions:

Capture of Data and Reporting:
- Perform lead duties in support of team in regard to data and reporting to include but not limited to: produce monthly reports and maintains dashboards from multiple systems, maintains other logs and spreadsheets (i.e.: CFB email, PSI log), maintain updated data needed by team (i.e.: Vizient Data), update written processes as directed by Data Quality Manager
- Collect and appropriately record data in auditing software and/or spreadsheets to include but not limited to: Cloudmed, EPIC, Institutional Audit Manager (IAM), and other spreadsheets at accuracy
- Work assignments in accordance with leadership direction communicate any outstanding negative impacts on CFB or work left undone
- Follow verbal and written processes and instructions
- Communicate messages verbally and via email in a manner to achieve an objective
- Capture troubleshoot on reported IT issues for the team to resolution serve as a Superuser for testing and updates for systems utilized by the team Perform Prebill and Retrospective Reviews:
- Validate assigned ICD-10-CM/PCS codes, abstracting data elements and DRGs are correct/appropriate according to official coding guidelines and supported by clinical documentation in the medical record. Performs audits at a minimum accuracy and productivity rate upon completion of audit
- Validate abstracting data to include but not limited to: POA, Point of Origin, Admission source, discharge disposition is correct
- Validate adherence to WellStar Coding Policies and Procedures
- Validate adherence to Wellstar Coding Query Policy
- Review and identify coding opportunities on mortality accounts using validation criteria from Vizient Risk Adjustment Calculator tool as well as other sources
- Identify query opportunities or other documentation improvements on reviews
- Serve as the department PSI (Patient Safety Indicator) subject matter expert for coding abstracting accuracy impact(s) based on AHRQ inclusion and exclusion criteria for PSIs
- Performs lead responsibilities in support of team in regard to audit reviews to include but not limited to: focused reviews, audit the auditor reviews, rebuttals. Provides verbal and written trending data citing opportunities and feedback for process improvements Onboarding, Education Mentoring:
- Onboard new Coding and Auditor staff. Oversee lead any onboarding performed by any outside vendor(s)
- Lead communication with the appropriate internal and external stakeholders relevant to auditing results education plans
- Communicate feedback to Coding CDI leadership as well as Coders on areas of opportunity relevant to coding, abstracting and documentation opportunities both verbally and through data reporting
- Participates in creation and roll out of action and process improvement plans to address opportunities
- Prepare educational materials, instructions and tip sheets for Coding and CDI teams, as necessary
- Serve as a subject matter expert for owning area, participate in meetings communicate coding knowledge complexities with internal and external stakeholders to include the CDI team
- Review and stay abreast of the latest state and federal regulatory guidelines, Official Coding Guidelines, official coding advice (coding clinic) and all coding updates. Communicate understanding, impacts implications for WHS
- Serve as a mentor for the team Coding Abstracting Accounts:
- Accurately and completely assign appropriate ICD-10-CM/PCS and/or CPT/HCPCS codes to the greatest specificity with a minimum accuracy rate in accordance with Coding and WHS guidelines
- Accurately and completely abstract all required data into the appropriate data fields in compliance with statistical data requirements with a minimum of accuracy rate
- Meet productivity standards
- Query physicians to further clarify code assignments, as necessary

Required Minimum Education:

Associate's Degree in Health Information Management, Business, or other health care related field Required
Bachelor's Degree in Health Information Management, Business, or other health care related field Preferred or

Required Minimum License(s) and Certification(s):
All certifications are required upon hire unless otherwise stated.

• Cert Coding Spec-Preferred or Reg Health Information Admin-Preferred or Reg Health Information Tech-Preferred

Additional License(s) and Certification(s):



Required Minimum Experience:

Minimum 1 year Served in a Coding Auditor Role at Wellstar for at least one year, is fully trained and maintains a accuracy in all areas within scope of work Required or
Minimum 3 years Hospital-based inpatient auditing experience currently meeting a accuracy in abstracting, coding and DRG assignment while meeting productivity requirements or passing score on the coding assessment provided by Coding department, if applicable. Required

Required Minimum Skills:

Extensive knowledge of medical terminology, disease processes, pharmacology, anatomy and physiology. High
Must have excellent organizational skills and be able to manage multiple tasks at one time, set priorities and achieve goals timely. High
Ability to learn and efficiently use various software systems: EPIC, 3M360, Institutional Audit Manager, Vizient, Cloudmed, Outlook, Teams and text messaging. High
Ability to articulate & communicate verbally & via email to achieve an objective & with critical thinking skills High
Able to identify creative, out of the box solutions to complex problems, analyze issues and opportunities to achieve and provide feedback and implement solutions to achieve a successful result. High
Serve as a mentor to the team, taking time to assist and being a source of information and insight. Provide an exchange of
knowledge, experience and goodwill to assist in growth for the team member High
Previous PSI (Patient Safety Indicator) auditing experience preferred. Medium

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