HIMS Coding Auditor

Riverside Health System; Tallahassee (FL); Remote; USD 40,000 - 55,000; Full time

Job summary

Riverside Health System is seeking a Clinical Coder with extensive experience in acute care coding to ensure high-quality documentation and coding compliance across inpatient and outpatient settings. You will audit records, support denial management, and educate teams to improve revenue integrity.

Responsibilities include applying coding guidelines, mentoring staff, coordinating with CDI and payor relations, and preparing audit reports for leadership.

Qualifications

• Maintain current working knowledge of ICD-9, ICD-10 and CPT coding principles, government regulation, protocols.
• Experience in auditing acute care IP and OP coding.
• Ability to adapt to changes in the work environment and communicate effectively.

Responsibilities

• Ensures coding compliance.
• Applies all coding guidelines and principles as defined in the Coding Clinic and leading authorities.
• Complies with standardized coding standards, conventions and regulations, corporate compliance standards and reimbursement policies.
• Identifies training needs and provides education to team members.
• May teach or coordinate coding huddles.
• Coaches and mentors staff.
• Performs focused reviews and quality audits.
• Prepares audit reports for leadership.
• Assists coding leadership with reviewing and responding to internal and external coding audits.
• Works with coding leadership in settlement of audit findings as needed.
• Monitors and evaluates the coding functions to ensure effective and efficient coding operations and compliance with established standards, rules and regulations.
• Audits for documentation opportunities to clarify confusing, incomplete or conflicting information and obtain any needed additional documentation if needed.
• Assists patient financial services and clinical documentation improvement team members with questions on coding and billing edits.
• Serves as a clinical coding liaison.
• Analyzes and evaluates documentation issues with consultation from the medical staff, clinical staff, CDI team and other departments as needed.
• Assists leadership with coordination of iCare initiatives related to the hospital coding department.
• Assists with DRG and certain CPT denials from payers as needed and writes appeals as indicated, documenting the denial/audit in denial management tool for tracking and reports.

Skills

ICD-9/ICD-10 & CPT coding knowledge

Auditing

Interpersonal skills

Communication skills

Education

High School Diploma or GED

Associates Degree in Healthcare or Related (Preferred)

Tools

Excel

PowerPoint

Word

Job description

Newport News, Virginia

Hiring Range $28.90 - $39.78/Hourly. Actual pay is determined based on job-related factors such as relevant experience, education, credentials, skills, internal equity, and business needs.

This position is remote work eligible for candidates residing in the following states: FL, GA, ID, KS, KY, MS, NC, OK, SC, SD, TN, VA.

Overview

Responsible for maintaining coded data quality through ongoing quality review and assessment of outpatient or inpatient records. Performs audits on accuracy of APC or MSDRGs as well as on quality of medical record documentation needed for accurate coding. Works with DRG and CPT denials from commercial payers and writes appeal letters as indicated.

What you will do

• Ensures coding compliance.
• Applies all coding guidelines and principles as defined in the Coding Clinic and leading authorities.
• Complies with standardized coding standards, conventions and regulations, corporate compliance standards and reimbursement policies.
• Identifies training needs and provides education to team members.
• May teach or coordinate coding huddles.
• Coaches and mentors staff.
• Performs focused reviews and quality audits.
• Prepares audit reports for leadership.
• Assists coding leadership with reviewing and responding to internal and external coding audits.
• Works with coding leadership in settlement of audit findings as needed.
• Monitors and evaluates the coding functions to ensure effective and efficient coding operations and compliance with established standards, rules and regulations.
• Audits for documentation opportunities to clarify confusing, incomplete or conflicting information and obtain any needed additional documentation if needed.
• Assists patient financial services and clinical documentation improvement team members with questions on coding and billing edits.
• Serves as a clinical coding liaison.
• Analyzes and evaluates documentation issues with consultation from the medical staff, clinical staff, CDI team and other departments as needed.
• Assists leadership with coordination of iCare initiatives related to the hospital coding department.
• Assists with DRG and certain CPT denials from payers as needed and writes appeals as indicated, documenting the denial/audit in denial management tool for tracking and reports.

Qualifications

Education

• High School Diploma or GED, (Required)
• Associates Degree, Healthcare or Related (Preferred)

Experience

• 5-6 years Acute Care Inpatient (IP) and Outpatient (OP) Coding (Required)
• 2 years Auditing - Acute Care IP and OP (Required)
• 1 year Clinical Documentation Integrity (Preferred)

Skills and Abilities

• Maintain current working knowledge of ICD-9, ICD-10 and CPT coding principles, government regulation, protocols
• Intermediate proficiency with Excel, PowerPoint, Word
• Skill in completing assignments accurately and with attention to detail
• Ability to adapt to changes in the work environment
• Excellent interpersonal skills and team oriented
• Ability to communicate effectively in both oral and written form

Licenses and Certifications

• Certified Coding Specialist (CCS) - The American Health Information Management Association (AHIMA) Upon Hire (Required)
• Registered Health Information Administrator (RHIA) - The American Health Information Management Association (AHIMA) Upon Hire (Preferred)
• Registered Health Information Technician (RHIT) - The American Health Information Management Association (AHIMA) Upon Hire (Preferred)
• Certified Clinical Document Specialist (CD) - Association of Clinical Documentation Integrity Specialists (ACDIS) CCDS
• Certified Clinical Documentation Specialist or CDIP Clinical Documentation Improvement Professional Upon Hire (Preferred)
• Certified Professional Coder (CPC) - American Academy of Professional Coders (AAPC) Upon Hire (Preferred)