Coding Quality Auditor

Hackensack Meridian Health; West Grove (NJ); Remote; USD 87,000 - 107,000; Full time

Job summary

Hackensack Meridian Health is seeking a Coding Quality Auditor to monitor clinical documentation for coding accuracy and compliant reimbursement. This 100% remote role requires attention to detail and strong analytical skills to support CDI initiatives.

You will review DRG assignments, address edits, and guide inpatient coders on coding guidelines. The position emphasizes collaboration with the HIM team and adherence to CMS/ICD-10 standards, audits, and performance metrics.

Qualifications

• Associate's degree or higher or equivalent coding experience (2-4 years).
• Minimum of 5 years of inpatient coding experience in a complex healthcare environment.
• Minimum 2 years of quality improvement audit.
• Experience and thorough knowledge of ICD-10 and DRG methodologies.
• Knowledge of data reporting requirements and proficiency in computer skills.
• Extensive knowledge in data collection and clinical coding reviews.
• Excellent written, verbal, and interpersonal communication skills.
• Proficient computer skills including but not limited to Microsoft Office and Google Suite platforms.

Responsibilities

• Reviews DRG assignment for selected Medicare/Medicaid inpatients for reimbursement and reporting.
• Analyzes physician documentation for coding accuracy and queries physicians as needed.
• Provides guidance on coding changes and education to Inpatient Coders.
• Applies reason/tracking code and rationale in 3M for DRG mismatches.
• Provides guidance to Clinical Documentation Specialists and education on coding guidelines.
• Performs data analysis and monthly reporting on DRG and compliance metrics.
• Makes recommendations on documentation improvement to enhance patient care.

Skills

Communication skills

Analytical thinking

Attention to detail

Team collaboration

Adaptability

Education

Associate's degree or higher in coding

Tools

3M coding system

Microsoft Office

Google Suite

Job description

Overview

Our team members are the heart of what makes us better.

At Hackensack Meridian Health we help our patients live better, healthier lives - and we help one another to succeed. With a culture rooted in connection and collaboration, our employees are team members. Here, competitive benefits are just the beginning. It’s also about how we support one another and how we show up for our community.

Together, we keep getting better - advancing our mission to transform healthcare and serve as a leader of positive change.

The Coding Quality Auditor is responsible for monitoring compliance with applicable clinical documentation to support coding and billing regulations to insure appropriate reimbursement and to support public reporting and various initiatives as directed by Hackensack Meridian Health (HMH) Network.

This position is 100% remote, the hours are 11 am - 7:30 pm and it require a team member to work one weekend day each week, Saturday or Sunday.

Responsibilities

A day in the life of a Coding Quality Auditor at Hackensack Meridian Health includes:

• Reviews Diagnosis Related Group (DRG) assignment for selected Medicare/Medicaid inpatients, Hospital-acquired condition (HAC), Patient Safety Indicators (PSI) and Healthgrade target diagnoses, mortalities and dual diagnosis (dx) for principal diagnosis (Pdx) for the purpose of reimbursement, research and statistics in compliance with federal regulations according to ICD-10 coding classification systems.
• Addressing all edits, including but not limited to nosology, Exihauser, PSI, HAC, and others as needed based on quality indicator.
• Analyzes physician documentation in the medical record for clinical correlation for coding accuracy and queries physicians when code assignments are not straightforward or documentation in the medical record is inadequate, ambiguous, or unclear for coding purposes.
• Provides guidance on any changes made during their review to the Inpatient Coders by furnishing input as necessary in addition to education regarding applicable coding clinics or coding guidelines.
• Apply reason/tracking code and rationale (if needed) in 3M as needed for DRG mismatches on Clinical Documentation Improvement (CDI) reviewed cases.
• Provides guidance to the Clinical Documentation Specialists by furnishing input as necessary in addition to education regarding applicable coding clinics or coding guidelines.
• Performs data analysis and statistical gathering on a monthly basis with regards to DRG, Public Reporting, HAC compliance which is then presented to the Chief Compliance Officer.
• Makes recommendations on documentation improvement needs within the facility to improve patient care. 9. Applies Present On Admission (POA) indicators on all inpatient charts. 10. Brings identified concerns to the supervisor or department manager for resolution.
• Enters data such as diagnosis and procedure codes and charts abstracted information for DRG assignments into the 3M coding computer system. 12. Assists and provides feedback to the Inpatient HIM Supervisor and Inpatient Coding Manager with education sessions for coding s. 13. Assists in chart completion to ensure Discharged not final billed (DNFB) goals are met.
• Assists in special projects when applicable such as in-house audits or audits pertaining to contract coders.
• Creates spreadsheets and summary of findings.
• Attends monthly coding educator in-services provided by the Inpatient Coding Educator.
• Assists the coding staff when needed.
• Keeps abreast of coding guidelines and reimbursement reporting requirements, new technology and procedures as well as Centers for Medicare & Medicaid Services (CMS) approved clinical trials.
• Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association and adheres to official coding guidelines.
• Other duties and/or projects as assigned.
• Adheres to HMH Organizational competencies and standards of behavior.

Qualifications

Education, Knowledge, Skills and Abilities Required:

• Associate's degree or higher or equivalent years of coding experience (2-4 years).
• Minimum of 5 years of inpatient coding experience in a complex healthcare environment.
• Minimum 2 years of quality improvement audit.
• Experience and thorough knowledge of ICD-10 and DRG methodologies.
• Knowledge of data reporting requirements and proficiency in computer skills.
• Extensive knowledge in data collection and clinical coding reviews.
• Excellent written, verbal, and interpersonal communication skills.
• Proficient computer skills including but not limited to Microsoft Office and Google Suite platforms.

Licenses and Certifications Required:

• Certified Coding Specialist.

Starting Minimum Rate

Minimum rate of $97,011.20 Annually

Job Posting Disclosure

HMH is committed to pay equity and transparency for our team members. The posted rate of pay in this job posting is a reasonable good faith estimate of the minimum base pay for this role at the time of posting in accordance with the New Jersey Pay Transparency Act and does not reflect the full value of our market-competitive total rewards package. The starting rate of pay is provided for informational purposes only and is not a guarantee of a specific offer. Posted hourly rates may be stated as an annual salary in the offer and posted annual salaries may be stated as an hourly rate in the offer, depending on the level and nature of the job duties and credentials of the candidate. The base compensation determined at the time of the offer may be different than the posted rate of pay based on a number of non-discriminatory factors, including but not limited to: Labor Market Data: Compensation is benchmarked against market data to ensure competitiveness. Experience: Years of relevant work experience. Education and Certifications: Level of education attained, including specialized certifications, credentials, completed apprenticeship programs or advanced training. Skills: Demonstrated proficiency in relevant skills and competencies. Geographic Location: Cost of living and market rates for the specific location. Internal Equity: Compensation is determined in a manner consistent with compensation ranges for similar roles within the organization. Budget and Grant Funding: Departmental budgets and any grant funding associated with the job position may impact the pay that can be offered. Some jobs may also be eligible for performance-based incentives, bonuses, or commissions not reflected in the starting rate. Certain positions may also be eligible for shift differentials for work performed on evening, night, or weekend shifts. In addition to our compensation for full-time and part-time (20+ hours/week) job positions, HMH offers a comprehensive benefits package, including health, dental, vision, paid leave, tuition reimbursement, and retirement benefits.