Outpatient Coding Compliance Auditor - FT - Days - Remote Eligible

CO010 Memorial Healthcare System; United States; Remote; USD 65,000 - 95,000; Full time

Job summary

Memorial Healthcare System is seeking a skilled auditor for inpatient and outpatient coding to ensure accurate ICD-10-CM/PCS and CPT coding, APC/MSDRG/APRDRG assignments, and compliant documentation. You will train staff and respond to regulatory changes affecting AHIMA guidelines.

Ideal candidates hold RHIA/RHIT/CCS credentials with at least three years of coding experience and a strong knowledge of coding systems, audits, and confidential data handling.

Qualifications

• Accredited Health Information Management program.
• CertifiedCoding Specialist (CCS) and RHIA/RHIT credentials preferred.
• Strong knowledge of ICD-10-CM/PCS, CPT coding principles and AHIMA guidelines.

Responsibilities

• Audit inpatient or outpatient medical records for correct ICD-10-CM/PCS, CPT, APC, MSDRG, APRDRG assignments.
• Provide training on coding guidelines and regulatory changes.
• Respond to coding denials and audits with well-documented queries.
• Serve as a coding resource and mentor to staff.
• Maintain strict patient confidentiality and comply with AHIMA standards.

Skills

ACCOUNTABILITY

ACCURACY

CUSTOMER SERVICE

EFFECTIVE COMMUNICATION

HUMAN ANATOMY

MEDICAL CODING

MEDICAL TERMINOLOGY

RESPONDING TO CHANGE

STANDARDS OF BEHAVIOR

Education

Health Information Management

RHIA

RHIT

CCS

Tools

Encoder

Electronic Medical Records (EMR)

Job description

Location

Miramar, Florida. At Memorial, we are dedicated to improving the health, well-being and, most of all, quality of life for the people entrusted to our care. An unwavering commitment to our service vision is what makes the difference. It is the foundation of The Memorial Experience.

Summary

Responsible for auditing coded inpatient or outpatient medical records applying ICD-10 CM/PCS and/or CPT-4. Reviews Ambulatory Payment Classification (APC), Medicare Severity Diagnosis Related Groups (MSDRG) and All Patients Refined Diagnosis Related Groups (APRDRG) assignment and queries following official coding guidelines and regulatory requirements. Provides training and education based on audit results and any regulatory changes that effect Federal, State and American Health Information Management Association (AHIMA) guidelines.

Responsibilities

Maintains strict adherence to patient confidentiality according to MHS standards and regulatory requirements.Works closely with inpatient and outpatient coding managers to analyze and resolve claim denials that are rejected by edits from the Revenue Cycle Department. Reviews and responds to all external coding denial audits using ICD-10CM/PCS, CPT and APC, MSDRG, and APRDRG audits.Conducts and reports on electronic medical record audits to verify ICD-10CM/PCS, CPT and APC, MSDRG, and APRDRG coding and grouping accuracy. Serves as an expert resource for all coding staff. Assists with developing specific departmental goals, standards, and objectives which directly support the strategic plan and vision of the organization.Maintains thorough knowledge of ICD-10CM/PCS, and CPT coding principles and guidelines; possesses substantial knowledge of MSDRG, APRDRG, APC, and Enhanced Ambulatory Patient Groups (EAPG) classification systems and query guidelines for compliant provider documentation.Coordinates, develops, and implements coder intern education and training. Training will align with AHIMA standards of ethical coding and official coding guidelines. Provides feedback based on audit results and tracks coder intern progression throughout the program.Holds educational sessions for coding specialists, documentation specialists, and physicians. Acts as a liaison for electronic physician query process. Utilizes coding audit results to tailor education to increase coding accuracy. Assists the coding staff to format compliant queries and assesses for compliance with AHIMA query standards. Reports results of coding and query compliance audits to management.Performs all other duties as assigned.

Competencies

ACCOUNTABILITY, ACCURACY, CUSTOMER SERVICE, EFFECTIVE COMMUNICATION, HUMAN ANATOMY, MEDICAL CODING, MEDICAL TERMINOLOGY (3), RESPONDING TO CHANGE, STANDARDS OF BEHAVIOR

Education and Certification Requirements

Accredited Program: Health Information Management (Required)Certified Coding Specialist (CCS) - American Health Information Management Association (AHIMA), Registered Health Information Administrator (RHIA) - American Health Information Management Association (AHIMA), Registered Health Information Technician (RHIT) - State of Florida (FL)

Additional Job Information

Complexity of Work: Requires critical thinking, decisive judgment, effective written and verbal communication skills. Demonstrates effective time management skills, professional responsibility and fosters teamwork. Able to work with minimal supervision. Must be able to work in a stressful environment and take appropriate action. Ability to accurately assign and sequence ICD-10-CM/PCS and CPT codes to principal diagnosis and procedures, complications and co-morbid conditions to complex inpatient or outpatient encounters such as observation, outpatient surgery and interventional radiology. Provides guidance to other departmental staff in identifying and resolving coding issues or errors. Proficient in basic computer skills including Microsoft Office applications and utilizing a computerized encoder and electronic medical record systems.

Required Work Experience

For inpatient coding auditor, three (3) years of inpatient coding experience. For outpatient coding auditor, three (3) years of outpatient coding experience.

Other Information

For Hospital Coding: Registered Health Information Administrator (RHIA) or Registered Health Information Technician (RHIT) or Certified Coding Specialist (CCS).For Physician Coding: CPC - Certified Professional Coder, HCC - Hierarchical Condition Category Coder, CRC - Certified Risk Adjustment Coder, or CPMA Certified Professional Medical Auditor.Additional Credential Info: Registered Health Information Administrator (RHIA) or Registered Health Information Technician (RHIT) or Certified Coding Specialist (CCS). For Physician Coding: CPC Certified Professional Coder, HCC - Hierarchical Condition Category Coder, CRC Certified Risk Adjustment Coder, or CPMA Certified Professional Medical Auditor.

Working Conditions and Physical Requirements

Bending and Stooping = 40% Climbing = 0% Keyboard Entry = 60% Kneeling = 40% Lifting/Carrying Patients 35 Pounds or Greater = 0% Lifting or Carrying 0 - 25 lbs Non-Patient = 40% Lifting or Carrying 2501 lbs - 75 lbs Non-Patient = 0% Lifting or Carrying > 75 lbs Non-Patient = 0% Pushing or Pulling 0 - 25 lbs Non-Patient = 40% Pushing or Pulling 26 - 75 lbs Non-Patient = 0% Pushing or Pulling > 75 lbs Non-Patient = 0% Reaching = 40% Repetitive Movement Foot/Leg = 0% Repetitive Movement Hand/Arm = 60% Running = 0% Sitting = 60% Squatting = 20% Standing = 60% Walking = 60% Audible Speech = 60% Hearing Acuity = 60% Smelling Acuity = 0% Taste Discrimination = 0% Depth Perception = 60% Distinguish Color = 60% Seeing - Far = 60% Seeing - Near = 60% Bio hazardous Waste = 0% Biological Hazards - Respiratory = 0% Biological Hazards - Skin or Ingestion = 0% Blood and/or Bodily Fluids = 0% Communicable Diseases and/or Pathogens = 0% Asbestos = 0% Cytotoxic Chemicals = 0% Dust = 0% Gas/Vapors/Fumes = 0% Hazardous Chemicals = 0% Hazardous Medication = 0% Latex = 0% Computer Monitor = 60% Domestic Animals = 0% Extreme Heat/Cold = 0% Fire Risk = 0% Hazardous Noise = 0% Heating Devices = 0% Hypoxia = 0% Laser/High Intensity Lights = 0% Magnetic Fields = 0% Moving Mechanical Parts = 0% Needles/Sharp Objects = 0% Potential Electric Shock = 60% Potential for Physical Assault = 0% Radiation = 0% Sudden Decompression During Flights = 0% Unprotected Heights = 0% Wet or Slippery Surfaces = 0% Shift: Primarily for office workers - not eligible for shift differential

Disclaimer

This job description is not intended, nor should it be construed to be an exhaustive list of all responsibilities, skills, efforts or working conditions associated with the job. It is intended to indicate the general nature and level of work performed by employees within this classification. Wages shown on independent job boards reflect market averages, not specific to any employer.

Equal Employment Opportunity

Memorial Healthcare System is proud to be an equal opportunity employer committed to workplace diversity. Memorial Healthcare System recruits, hires and promotes qualified candidates for employment opportunities without regard to race, color, age, religion, gender, sexual orientation, national origin, veteran status, disability, genetic information, or any factor prohibited by law.

Veteran’s Preference

We are proud to offer Veteran’s Preference to former military, reservists and military spouses (including widows and widowers). You must indicate your status on your application to take advantage of this program. Employment is subject to post offer, pre-placement assessment, including drug testing. What should I do if I am eligible for Veteran’s Preference? You must claim your Veteran’s Preference status on your application. If selected for a job, you must provide documentation regarding your status. How does Memorial verify that someone is eligible for Veteran’s Preference? We require specific documentation as determined by the basis for which someone claims preference. For example, the documentation for a disabled veteran is different from the documentation required for the spouse of a veteran killed in the line of duty. How often can an eligible person claim Veteran's Preference at Memorial? There is no limit to how often internal or external applicants can use preference when a job is posted externally on our career website or elsewhere. What if there are two equally qualified, preference-eligible job applicants? In this case, the selection is based on the eligibility category in accordance with Florida law. First preference is given to: An honorably discharged veteran who has served on active duty and has a service-connected, compensable disability. A spouse of a person who has a total, permanent, service-connected disability and cannot qualify for employment. A spouse of a person missing in action, captured or forcibly detained or interned by a foreign government or power.

If you feel you have been unfairly denied Veteran’s Preference by Memorial Healthcare System, please contact [e-mail]. You may also file a complaint with the Florida Department of Veterans’ Affairs (FDVA).

Be where care matters. At Memorial Healthcare System, we are dedicated to improving the health, well‑being, and quality of life of the people entrusted to our care. This unwavering commitment to our service vision makes the difference and is the foundation of The Memorial Experience. Deeper Caring. Smarter Healthcare. Talk to our patients and their families about "Deeper Caring," and they'll tell you stories about miracle babies, lives saved through sheer determination, and the comforting kindness of others. About people who advocated for the family’s best interests and cared for them in body, mind, and spirit. For our employees, “Smarter Healthcare” means constantly improving how we deliver care. It could be a new technology, a streamlined process, or a cutting‑edge program leveraging our system strengths. But, no matter how you look at it, our service vision is integral to our culture today and what we strive to be tomorrow. We invite you to share in the Memorial Experience – where touching lives, lifting spirits, and healing the human body is our profession’s greatest privilege and reward. Be where you are valued. Memorial Healthcare System provides preference as part of our commitment to honoring the service and sacrifice of veterans in alignment with state regulations. Veteran’s Preference allows for the first choice in interviewing, hiring, retention, and promotion after deployment when all other applicant qualifications are equal. However, Veteran's Preference does not guarantee a job.

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