Remote Inpatient Coding Compliance Auditor

Memorial Healthcare System; Hollywood (FL); Remote; USD 60,000 - 80,000; Full time

Job summary

A leading healthcare provider is searching for a qualified Coding Auditor to perform audits of inpatient and outpatient medical records. This role requires substantial knowledge in coding principles and certifications from AHIMA. The auditor will also provide training and be instrumental in resolving claims denials, ensuring compliance with healthcare standards.

Qualifications

• 3 years inpatient coding experience for inpatient auditor.
• 3 years outpatient coding experience for outpatient auditor.
• Certification from AHIMA is required.

Responsibilities

• Conduct audits to verify coding accuracy for inpatient and outpatient records.
• Provide training for coding specialists and documentation experts.
• Analyze and resolve claims denials.

Skills

ICD-10CM / PCS

CPT coding principles

MSDRG

APRDRG

patient confidentiality

education and training

Education

Health Information Management degree

Certified Coding Specialist (CCS)

Registered Health Information Administrator (RHIA)

Registered Health Information Technician (RHIT)

Job description

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 :

• Performs all other duties as assigned.
• 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.
• Maintains strict adherence to patient confidentiality according to MHS Standards and regulatory requirements.
• 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.
• 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.
• 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.
• 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.

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)

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.