Coding Quality Auditor

Houston Methodist; Washington (District of Columbia); On-site; USD 70,000 - 90,000; Full time

Job summary

A leading healthcare organization is seeking a Coding Quality Auditor to ensure coding accuracy and compliance with established guidelines. The role involves reviewing data integrity, participating in quality improvement projects, and collaborating with various departments. Candidates should have significant coding experience and relevant certifications.

Qualifications

• Minimum of five years of coding experience relevant to auditing.
• Required certifications: RHIT, RHIA, CCS, CCS-P, or CPC.
• Proficiency in medical terminology and electronic systems.

Responsibilities

• Ensure accuracy in code assignment for diagnoses and procedures.
• Participate in quality review and performance improvement projects.
• Respond to coding requests and assist with documentation training.

Skills

Medical terminology

Data analysis

Effective communication

Customer service focus

Education

Associate's degree or higher in Health Informatics

Job description

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

At Houston Methodist, the Coding Quality Auditor is responsible for ensuring accuracy in code assignment of diagnoses and procedures for outpatient and inpatient encounters, based on documentation within the electronic medical record, while maintaining compliance with established rules and regulatory guidelines. This role involves data quality review to ensure data integrity, coding accuracy, and revenue preservation. Additional duties include participating in quality review and performance improvement projects across the department and/or facility.

People Essential Functions

1. Interact and communicate effectively with team members, HIM, physicians, nurses, IT, Quality Operations, Case Management, Patient Access, and Business Office.
2. Participate in coding meetings, education in-services, and share knowledge on coding guidelines.

Service Essential Functions

1. Respond promptly to coding/DRG requests from internal and external customers, including the Business Office.
2. Initiate queries with physicians for diagnosis and procedure clarification, and assist with coding and documentation training.
3. Assist with quality assurance reviews, identify improvement opportunities, and recommend enhancements.
4. Support Case Management and Patient Access in coding for pre-admission and pre-certification, and develop documentation protocols.

Quality/Safety Essential Functions

1. Maintain high standards of coding quality, assigning accurate codes in accordance with hospital policies and guidelines.
2. Perform accurate DRG and APC assignments based on documentation.
3. Review discharge dispositions and correct as needed.
4. Abstract data into systems, ensuring accuracy of diagnoses, procedures, and physician information.
5. Conduct quality reviews and ensure adherence to ethical coding standards.
6. Compile reports for management based on review data.

Finance Essential Functions

1. Code and abstract efficiently, ensuring accuracy and productivity.
2. Monitor work queues and meet coding timeframes.

Growth/Innovation Essential Functions

1. Continuously evaluate performance, accept feedback, and seek improvement.
2. Contribute ideas for improving coding quality and processes.

Additional responsibilities may be assigned as needed. Houston Methodist reserves the right to revise duties as necessary.

Education

• Associate's degree or higher in a program accredited by the Commission on Accreditation in Health Informatics and Information Management, or equivalent experience.

Work Experience

• Minimum of five years of coding experience relevant to auditing (e.g., inpatient, outpatient, professional fee).

Licenses and Certifications - Required

• RHIT, RHIA, CCS, CCS-P, or CPC, as applicable to coding area.

Knowledge, Skills, and Abilities

• Proficiency in medical terminology, anatomy, physiology, and electronic systems.
• Effective communication skills and customer service focus.
• Ability to perform and support quality reviews and data analysis.