Hospital Coding Quality Specialist - Integrity

Advocate Aurora Health; United States; Remote; USD 60,000 - 100,000; Full time

Job summary

An established industry player seeks a detail-oriented Coding Specialist for a remote opportunity. In this role, you will ensure the accuracy and compliance of health information records, collaborating closely with coding leadership to enhance coding quality. Your expertise in ICD-10-CM/PCS and CPT will be crucial as you identify education opportunities and improve coding practices. This position offers a chance to make a significant impact in a complex healthcare environment while maintaining your credentials and staying updated with industry trends. If you are passionate about healthcare coding and looking for a rewarding remote role, this is the perfect opportunity for you.

Qualifications

• 5+ years in hospital coding within a large healthcare system.
• Licensure as CCS, RHIA, or RHIT required.

Responsibilities

• Review coded health information for accuracy and compliance.
• Collaborate with coding leadership on documentation quality.

Skills

ICD-10-CM/PCS

CPT

HCPCS

Microsoft Office

Analytical Skills

Communication Skills

Attention to Detail

Education

Associate's Degree in Health Information Management

Tools

Electronic Health Records

Job description

Department:

13244 Revenue Cycle - Facility Coding Quality Integrity

Status:

Full time

Benefits Eligible:

Yes

Hours Per Week:

40

Schedule Details/Additional Information:

This is a REMOTE opportunity.

Inpatient experience desired.

Major Responsibilities:

1. Review coded health information records to evaluate the quality of staff coding and abstracting, verifying accuracy and appropriateness of diagnostic and procedure codes, and other data such as discharge disposition. Ensure accurate coding for outpatient, day surgery, and inpatient records, following AHA coding guidelines, CPT Assistant, AHA Coding Clinic, and coverage decisions.
2. Collaborate with coding leadership to review records with focused diagnosis and procedure codes, including APCs, DRGs, and OIG work plan targets, ensuring compliance and documentation quality.
3. Identify coding education opportunities and team trends to improve coding accuracy and compliance.
4. Review flagged encounters, including HACs, complications, and other records, for appropriate risk adjustment and severity/mortality assignments.
5. Participate in clinical documentation improvement and hospital coding alignment, reviewing mismatched DRGs and providing rationale for documentation and coding adjustments.
6. Assist in hospital coding denial and appeal processes, ensuring timely responses and appropriate appeals based on guidelines and documentation.
7. Follow up on overpayment or underpayment denials, rebilling as necessary, and report trends to leadership.
8. Resolve coding-related inquiries from billing or patient accounts, ensuring claims are not delayed and coding practices are clarified.
9. Maintain continuing education and credentials, staying current with industry trends, legislation, and technology.

Licensure, Registration, and/or Certification Required:

• Coding Specialist (CCS), or
• Health Information Administrator (RHIA), or
• Health Information Technician (RHIT), all issued by AHIMA.

Education Required:

• Associate's Degree in Health Information Management or a related field.

Experience Required:

• Typically 5 years in hospital coding within a large, complex healthcare system, including denial review and coding quality functions.

Knowledge, Skills & Abilities:

• Leadership skills and knowledge of NCCI edits and coverage decisions.
• Expertise in ICD-10-CM/PCS, CPT, G-codes, HCPCS, modifiers, APCs, and MS-DRGs.
• Proficiency in Microsoft Office applications.
• Strong understanding of anatomy, physiology, medical terminology, and pharmacology.
• Experience with electronic health records and coding workflows.
• Excellent communication, analytical skills, attention to detail, and ability to work remotely.

Physical Requirements and Working Conditions:

• Normal office environment, ability to sit for long periods, and maintain concentration.
• Potential travel to other sites, with associated hazards.