Coding Auditor Senior Facility

McLaren Health Care; Grand Blanc (MI); On-site; USD 85,000 - 115,000; Full time

Job summary

McLaren Health Care is seeking a Senior Coding Auditor to provide ongoing coding and documentation education for physicians, coders, and CDI teams to ensure accurate code assignment and appropriate charges across hospital services.

Responsibilities include conducting audits, validating POA indicators, and supporting the Clinical Validation Initiatives with transparency and collaboration across the coding and clinical teams.

Qualifications

• High School diploma required.
• 5 years of coding experience.
• Certified in AHIMA, AAPC, or AMAC.
• Experience auditing inpatient/outpatient coding and billing.

Responsibilities

• Completes quality assurance audits on inpatient and outpatient coding specialists, onboarding audits and training of newly hired coding specialists.
• Validates POA indicators according to guidelines and identifies missing or inappropriate queries to providers.
• Audits outpatient and/or inpatient facility coding and billing using MS-DRG or APC assignment and OPPS reimbursement methodology; develops guides with CDI for identified conditions.
• Serves as an advisor and support to the Auditor.
• Performs retrospective, random, and focused audits of coding cases to ensure accurate code application.
• Performs pre-bill compliance audits to ensure accurate code assignment and regulatory compliance.

Skills

5 years coding experience

Education

High School diploma

Associate degree in HIT or related healthcare field

AHIMA Certification (RHIA/RHIT/CCS)

AAPC Certification (CPC/CCC/COC/CHONC)

AMAC Certification ROCC

Job description

Position Summary:

Responsible for working with and providing on-going coding and documentation education (quarterly, annually and ad-hock) for physicians, coders, ancillary department staff, clinical documentation improvement (CDI), and other allied health professionals to improve documentation of patient care and to appropriately assign codes and/or determine charges to support those services.

Essential Functions and Responsibilities As Assigned:

1. Completes quality assurance audits on inpatient and outpatient coding specialists, onboarding audits and training of newly hired coding specialists, validating the coding specialist is accurately abstracting data into medical record systems, following coding guidelines and directives.
2. Validates Present on Admission (POA) indicators according to guidelines and identifies any missing or inappropriate queries to providers.
3. Uses payment methodology to audit outpatient and/or inpatient facility coding and billing, MS-DRG or APC assignment, and OPPS reimbursement methodology and shares knowledge with colleagues and clinical team members. Senior Auditor will support the Clinical Validation Initiatives with identifying cases for review and resolution, developing guides for the Clinical Validation Guidebook in partnership with CDI for each identified complication or disease during the Clinical Validation Meetings.
4. Serves as an advisor and support to the Auditor.
5. Performs retrospective, random, and focused audits of coding cases to ensure accurate code application and overall coding quality.
6. Performs periodic and ongoing pre-bill compliance audits to ensure accurate code assignment, application of coding guidelines, and compliance with external regulatory and accreditation requirements.

Qualifications:

Required:

• High School diploma
• 5 years of coding experience
• Certified in at least one of the following:
• o AHIMA Certification (such as: RHIA, RHIT, CCS)
• o AAPC (such as: CPC, CCC, COC, CIC, CHONC, etc.)
• o AMAC Certification such as: ROCC (radiation Oncology Certified Coder)

Preferred:

• Associate degree in HIT, Applied Science, Liberal Arts or other related healthcare field
• AAPC Specialty Certification (such as: CIRCC, CPMA)