Coding Compliance Auditor 1, HIM

Jackson Health System; Miami (FL); On-site; USD 55,000 - 75,000; Full time

Job summary

Jackson Health System in Miami, FL is seeking an HIM Coding Compliance Auditor 1 to analyze abstracted and coded data for accurate DNFB management, AHCA data submissions and PFS communication.

The role requires 5–7 years of related experience, strong analytical skills and the ability to collaborate with PFS and clinical staff to ensure coding compliance across ICD-9-CM, CPT-4 and related guidelines, while maintaining high professional standards.

Qualifications

• High school diploma required; bachelor's degree preferred.
• Strong analytical and organizational skills.
• Ability to communicate effectively in writing and verbally.
• Knowledge of healthcare coding concepts and relevant regulations.

Responsibilities

• Reviews quality of coded and abstracted data assuring coding compliance within the Jackson Health System.
• Performs target and focused MS-DRG, APC, CPT, Case mix and Medical Necessity reviews.
• Identifies monitors and corrects rejected claims due to HIM coding.
• Works as a liaison with PFS and other internal departments to facilitate reimbursement.
• Develops training protocols for coders on ICD-9-CM, CPT-4, APCs and coding guidelines.
• Collaborates with Coding Manager to achieve departmental goals.
• Assists in preparation of policies related to coding and abstracting.
• Communicates effectively with supervisors, managers, peers, hospital personnel and physicians.

Skills

Data analysis

Prioritization

Communication

Critical thinking

Independent judgment

Problem solving

Education

High school diploma

Bachelor's degree in related field

Job description

Miami, FL Full-Time Health Information Management

Jackson Health System

Full Time

Summary

The HIM Coding Compliance Auditor 1 analyzes abstracted/coded data for the purpose of ensuring accuracy and timeliness as it relates to DNFB management, quarterly AHCA data submissions and PFS communication.

Responsibilities

• Reviews quality of coded and abstracted data assuring coding compliance within the Jackson Health System.
• Performs target and focused MS-DRG, APC, CPT, Case mix and Medical Necessity reviews.
• Identifies monitors and corrects rejected claims due to HIM coding.
• Works as a liaison with PFS and other internal departments to serve as a communicator/problem-solver for hindrances that prevent reimbursement.
• Based on new coding requirements, audit findings, RACs, MACs, etc. prioritizes and supports develops training/education protocols for UHS hospital coders in ICD-9-CM, CPT-4, APCs, Emergency Room Evaluation and Management Coding, Level II coding guidelines, modifier guidelines, proper diagnosis and procedure code selection.
• Works as a team member to achieve departmental goals and perform other duties as requested by Coding Manager.
• Assist as needed in the coding and abstracting process.
• Assists in preparation of policies related to coding and abstracting.
• Communicates effectively with supervisors, managers, peers, hospital personnel and physicians.
• Identifies and communicates Coding best practices across HIM, Clinical assuring compliance to health care regulations, standards and guidelines, i.e., CMS, JCAHO, AHIMA, etc.
• Performs all other related job duties as assigned.

Experience

• Generally requires 5 to 7 years of related experience.

Education

• High school diploma is required. Bachelor's degree in related field is strongly preferred.

Skill

• Ability to analyze, organize and prioritize work accurately while meeting multiple deadlines.
• Ability to communicate effectively in both oral and written form.
• Ability to handle difficult and stressful situations with critical thinking and professional composure.
• Ability to understand and follow instructions.
• Ability to exercise sound and independent judgment.
• Knowledge and skill in use of job appropriate technology and software applications.

Valid license or certification is required as needed, based on the job or specialty.

Jackson Health System is an equal opportunity employer and makes employment decisions without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, disability status, age, or any other status protected by law