Coding Compliance Auditor, Remote

University of Maryland Medical System; Baltimore (MD); On-site; USD 45,460 - 64,747; Full time

Job summary

University of Maryland Medical System seeks a clinical coding auditor to ensure accurate ICD-10-CM/PCS and CPT-4 coding across inpatient and outpatient encounters. The role involves auditing complex cases, advising CDI staff, and providing training to new employees.

Responsibilities include monitoring coder productivity, reporting accuracy, and collaborating with hospital departments to resolve coding issues while adhering to AHIMA standards and system policies.

Qualifications

• Formal ICD-10-CM, ICD-10-PCS, CPT-4 training.
• Associates or Bachelor’s degree; education may substitute for experience.
• 2+ years ICD-10-CM/ICD-10-PCS coding and abstracting experience with at a Level 1 Trauma hospital or 4 years of experience with coding inpatient hospital medical records.

Responsibilities

• Serves as a clinical coding subject matter expert, and utilizes critical thinking to analyze and evaluate documentation issues with consultation from the medical and clinical staff, and clinical documentation specialists as needed.
• Audits ICD-10 diagnostic codes and CPT-4 procedure codes to outpatient, ambulatory surgery, and observation visits for the purpose of reimbursement, research and compliance with federal and state regulations.
• Audits complex inpatient cases such as trauma, rehab, neurology, critical care, etc. utilizing the ICD-10-CM and ICD-10-PCS nomenclature to ensure accurate APR-DRG/SOI/ROM and POA assignment.
• Serves in an advisory and educator role for Coding Specialists. Serves as communicator between Clinical Documentation Specialists and Coding. Researches new surgical procedures and technology. Provides training to new employees
• Reports coding quality accuracy rate for each coder
• Monitors productivity rate for each coder
• Conducts specialized focused audits as needed.
• Communicates with various departments within the hospitals regarding coding accuracy. Refers any problems to management timely, providing clear details. Assist coding specialists in writing appropriate coding queries, works collaboratively with CDI, understand Potentially Preventable Complications (PPC’s)/Maryland Hospital Acquired Conditions (MHAC’s), Prevention Quality Indicators (PQI’s) and their impact and other indicators as needed.
• Complies with AHIMA standards of ethical coding and coding compliance guidelines.
• Demonstrates support and compliance with University of Maryland Medical System mission, vision, values statement, goals and objectives and policies. Performs other duties or projects such as coding corrections as assigned by the manager.

Skills

ICD-10-CM/ICD-10-PCS coding

CPT-4 coding

Medical records abstracting

Critical thinking

Education

CCS

RHIT

RHIA

CIC

Job description

Job Requirements

Accurately audits hospital Inpatient, Ambulatory Surgery, Observation, and any other outpatient encounter visit for the purpose of appropriate reimbursement, research and compliance with federal and state regulations according to established ICD-10-CM/PCS coding and/or CPT-4 procedure coding classification systems.

Accurately audits hospital Inpatient, Ambulatory Surgery, Observation, and any other outpatient encounter visit for the purpose of appropriate reimbursement, research and compliance with federal and state regulations according to established ICD-10-CM/PCS coding and/or CPT-4 procedure coding classification systems.

Principal Responsibilities And Tasks

The following statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all job duties performed by personnel so classified.

• Serves as a clinical coding subject matter expert, and utilizes critical thinking to analyze and evaluate documentation issues with consultation from the medical and clinical staff, and clinical documentation specialists as needed.
• Audits ICD-10 diagnostic codes and CPT-4 procedure codes to outpatient, ambulatory surgery, and observation visits for the purpose of reimbursement, research and compliance with federal and state regulations.
• Audits complex inpatient cases such as trauma, rehab, neurology, critical care, etc. utilizing the ICD-10-CM and ICD-10-PCS nomenclature to ensure accurate APR-DRG/SOI/ROM and POA assignment.
• Serves in an advisory and educator role for Coding Specialists. Serves as communicator between Clinical Documentation Specialists and Coding. Researches new surgical procedures and technology. Provides training to new employees
• Reports coding quality accuracy rate for each coder
• Monitors productivity rate for each coder
• Conducts specialized focused audits as needed.
• Communicates with various departments within the hospitals regarding coding accuracy. Refers any problems to management timely, providing clear details. Assist coding specialists in writing appropriate coding queries, works collaboratively with CDI, understand Potentially Preventable Complications (PPC’s)/Maryland Hospital Acquired Conditions (MHAC’s), Prevention Quality Indicators (PQI’s) and their impact and other indicators as needed.
• Complies with AHIMA standards of ethical coding and coding compliance guidelines.
• Demonstrates support and compliance with University of Maryland Medical System mission, vision, values statement, goals and objectives and policies. Performs other duties or projects such as coding corrections as assigned by the manager.

Work Experience

Education and Experience

• High School graduate or equivalent. Formal ICD-10-CM, ICD-10-PCS, CPT-4 training. Associates or Bachelor’s degree. Education will be considered in lieu of experience.
• Minimum of two years ICD-10-CM/ICD-10-PCS coding and abstracting experience with at a Level 1 Trauma hospital or 4 years of experience with coding inpatient hospital medical records. 2-3 Years Ambulatory coding experience.
• One of the following: Certified Coding Specialist (CCS), Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), Certified Inpatient Coder (CIC)

Compensation

Benefits

$33.46 - $46.70/hr