Coding Denial Auditor

R1 is a leading provider of technology-enabled revenue cycle management services which transform and solve challenges across health systems, hospitals and physician practices. Headquartered in Chicago, R1 is publicly-traded organization with employees throughout the US and international locations. 

Our mission is to be the one trusted partner to manage revenue, so providers and patients can focus on what matters most. Our priority is to always do what is best for our clients, patient’s and each other. With our proven and scalable operating model, we complement a healthcare organization’s infrastructure, quickly driving sustainable improvements to net patient revenue and cash flows while reducing operating costs and enhancing the patient experience. 

The Coding Denial Auditor will be responsible for reviewing denial coded cases for coding completeness and accuracy.  This person will identify potential coding and DRG errors, researches appropriate guidelines to support recommended changes, and communicates the changes to the coder involved on a timely basis. The Reviewer provides expert coding advice to coding staff and relays needed coding educational topics to the Regional Manager, IP Coding Quality.  

Responsibilities:   

• Audits records as defined in the coding quality review plan. Review cases flagged by the coding quality software on a daily basis for multiple hospitals, including validating the completeness of documentation, identifying diagnoses and procedures that have been missed, proposing physician queries, and ensuring the accuracy of diagnoses, procedures, POA, discharge disposition and DRG assignment 

• Perform retrospective coding quality reviews as requested 

• Follows, and maintains up-to-date knowledge of, industry coding and documentation guidelines (e.g., Official ICD-10 Coding and Billing Guidelines, Coding Clinic advice, R1 and Ascension coding policies and procedures, and AHIMA/ACDIS Query Guidelines) so as to maintain system-wide coding consistency and remain in compliance with governmental and other regulatory guidelines 

• Communicates audit findings with coders in a timely manner and supports the teams in effectively and efficiently addressing and resolving local coding issues 

• Maintains both a high productivity rate and a high accuracy rate in accordance with established auditing standards 

• Serves as an inpatient coding expert & resource for the coding teams and other departments 

• Works with the Regional Manager to identify areas of educational need based on audit results 

• Reports to, and works with, the Regional Manager to identify improvements in the audit software tool, workflow processes and flag management; and assist with evaluation and testing of audit applications and updates as needed 

• Work with the hospital’s CDI team to address and resolve documentation issues 

• Assists with compilation, generation and analysis of data for results reporting and performance Improvement initiatives 

• Contributes to the reduction of the hospital's and Company’s coding compliance risks and contributes to the Company’s revenue enhancement goals 

• Maintains an open dialogue and a good working relationship with team members in order to advance the mission and objectives of the hospitals and R1 

• Assists with training of new auditors. Assists with other audits and duties as requested 

Pacific Time Zone working hours

Required Qualifications:   

• Bachelor's or Associates Degree with CCS credential is required 

• A minimum of seven (7) years of hospital inpatient coding experience is required 

• Extensive knowledge of ICD-10-CM/PCS classification system and MS-DRG and APR-DRG methodologies is required 

• In-depth knowledge of medical terminology, human anatomy/physiology, pharmacology, and pathology is required 

• Expert and up-to-date knowledge of industry Official Coding and Reporting Guidelines along with CMS and other agency directives for ICD-10 coding 

• Must have proficient MS Office computer skills, specifically in Excel and knowledge of various coding software/platforms and EMRs 

• Must be detail-oriented and have the ability to work independently and maintain a high productivity rate and coding accuracy rate 

• Ability to interact with other employees through effective communication Must be a self-starter 

Desired Qualifications:   

• Two (2) years of inpatient coding audit experience is preferred 

• Experience in a large (> 500 beds) hospital or multi-hospital health system is preferred 

• Training in hospital Clinical Documentation Improvement is preferred 

• Experience as a Coding Consultant with a consulting firm is preferred 

• Working in an evolving healthcare setting, we use our shared expertise to deliver innovative solutions. Our fast-growing team has opportunities to learn and grow through rewarding interactions, collaboration and the freedom to explore professional interests. 

Our associates are given valuable opportunities to contribute, to innovate and create meaningful work that makes an impact in the communities we serve around the world. We also offer a culture of excellence that drives customer success and improves patient care. We believe in giving back to the community and offer a competitive benefits package. To learn more, visit: r1rcm.com.