Coding Auditor Senior Facility

Mclaren-Health-Care; Grand Blanc (MI); On-site; USD 90,000 - 120,000; Full time

Job summary

McLaren Health Care Corporation seeks a Senior Medical Coding Auditor to guide ongoing coding education for physicians, coders, and CDI staff and to ensure accurate code assignment. You will audit inpatient and outpatient coding, validate POA indicators and support clinical validation initiatives with CDI.

Experience includes 3 years in medical coding audits, familiarity with MS-DRG/APC systems, and related certifications such as RHIA/RHIT/CCS or CPC/CIRCC/ROCC.

Qualifications

• AHIMA Certification such as RHIA, RHIT or CCS.
• AAPC Certification such as CPC, CCC, COC, CIC, CHONC, etc.
• AMAC Certification such as ROCC (Radiation Oncology Certified Coder).
• 3 years’ experience conducting medical coding audits and quality performance measures.

Responsibilities

• Completes quality assurance audits on inpatient and outpatient coding specialists, onboarding audits and training of newly hired coding specialists.
• Validates POA indicators and identifies missing or inappropriate queries to providers.
• Uses payment methodology to audit MS-DRG or APC assignment and OPPS reimbursement; develops guides with CDI.
• Serves as advisor and support to the Auditor.
• Performs retrospective, random, and focused audits to ensure accurate code application.
• Performs ongoing pre-bill compliance audits to ensure coding guidelines compliance.

Skills

Quality auditing

Medical coding

Education

RHIA/RHIT/CCS Certification

CPC/CCC/COC/CIC/CHONC Certification

AMAC ROCC Certification

Associate degree in HIT / Applied Science / Liberal Arts or related healthcare field

Job description

The McLaren system includes 12 hospitals across the state, ambulatory surgery centers, imaging centers, a 730-member employed primary and specialty care physician network, commercial and Medicaid HMOs covering more than 242,000 Michigan lives, home health, infusion and hospice providers, pharmacy services, a clinical laboratory network, and a wholly owned medical malpractice insurance company. McLaren operates Michigan’s largest network of cancer centers and providers, anchored by the Karmanos Cancer Institute, a National Cancer Institute-designated comprehensive cancer center. McLaren has 20,000 full-, part-time and contracted employees and more than 93,000 network providers throughout Michigan.

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.

• AHIMA Certification (such as: RHIA, RHIT, CCS)
• AAPC (such as: CPC, CCC, COC, CIC, CHONC, etc.)
• AMAC Certification such as: ROCC (radiation Oncology Certified Coder)
• 3 years’ experience conducting medical coding audits and quality performance measures.

Preferred:

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

Additional Information

• Schedule: Full-time
• Requisition ID: 26012235
• Daily Work Times: 8am - 4:30pm
• On Call: No

McLaren Health Care is an Equal Opportunity Employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sexual orientation, gender identification, age, sex, marital status, national origin, disability, genetic information, height or weight, protected veteran or other classification protected by law.

McLaren Health Care is an Equal Opportunity Employer. Qualified applicants will receive consideration for employmentwithout regard to race, color, religion, sexual orientation, gender identification, age, sex, marital status,national origin, disability, genetic information, height or weight, protected veteran or other classificationprotected by law.