Coding Quality Auditor

Houston Methodist; Nashville (TN); On-site; USD 50,000 - 80,000; Full time

Job summary

An established industry player is seeking a detail-oriented Coding Quality Auditor to ensure accuracy in code assignments for both outpatient and inpatient encounters. This role involves collaborating with diverse teams, conducting quality assurance reviews, and maintaining compliance with regulatory guidelines. The ideal candidate will have a strong background in coding, effective communication skills, and a commitment to continuous improvement. Join a forward-thinking organization that values quality and innovation in healthcare coding, and contribute to impactful quality and performance improvement projects.

Qualifications

• Associate's degree or higher in Health Information Management or equivalent experience.
• Minimum of five years coding experience relevant to auditing.

Responsibilities

• Ensure accuracy in code assignment for outpatient and inpatient encounters.
• Perform quality assurance reviews to ensure data integrity and coding accuracy.

Skills

Medical Terminology

Coding Accuracy

Effective Communication

Data Integrity

Education

Associate's Degree in Health Information Management

5+ Years Coding Experience

Tools

Electronic Coding Systems

Job description

Join us to apply for the Coding Quality Auditor role at Houston Methodist.

This position is responsible for ensuring accuracy in code assignment of diagnoses and procedures for outpatient and inpatient encounters, based on documentation within electronic medical records, while maintaining compliance with regulatory guidelines. The role involves data quality review, coding accuracy, revenue preservation, and participating in quality and performance improvement projects.

Essential Functions

• Collaborate effectively with the coding team, HIM, physicians, nurses, IT, Quality Operations, Case Management, Patient Access, and Business Office.
• Participate in coding meetings, education in-services, and share knowledge of coding guidelines.
• Respond promptly to coding/DRG requests from internal and external customers, including the Business Office.
• Initiate queries with physicians for diagnosis and procedure clarification and assist with clinical documentation management and coding training.
• Perform quality assurance reviews to ensure data integrity and coding accuracy, and recommend improvements.
• Support Case Management and Patient Access with CPT coding for pre-admission and pre-certification, and develop documentation protocols.

Quality/Safety Functions

• Maintain high standards of coding quality, assign accurate ICD and CPT codes, and perform DRG and APC assignments.
• Review discharge dispositions, ensure correct physician identification, and abstract data accurately.
• Assist with outpatient/inpatient account reviews, adhere to ethical coding standards, and compile reports for management.

Financial Functions

• Code and abstract efficiently while ensuring accuracy, monitor worklists, and meet productivity standards.

Growth and Innovation

• Evaluate personal performance, accept feedback, and contribute ideas for improving coding quality and processes.

Qualifications

• Associate's degree or higher in a recognized Health Information Management program, or equivalent experience.
• Minimum of five years coding experience relevant to auditing (inpatient, outpatient, or professional fee).
• Certifications: RHIT, RHIA, CCS, CCS-P, or CPC.

Knowledge, Skills, and Abilities

• Proficiency in medical terminology, anatomy, physiology, and electronic coding systems.
• Effective communication skills and ability to work with diverse teams and documentation systems.

This role requires professional attire, may involve travel within and outside the Houston area, and may require on-call availability during emergencies. Houston Methodist is an Equal Opportunity Employer.