Clinical Coding Auditor - FT - Remote

Texas Health Resources•Arlington, TX

14h•Remote

About The Position

The Clinical Coding Auditor is responsible for auditing medical records to ensure the accuracy of assigned codes and DRG/APC groupings. This role validates the accuracy of ICD-10-CM, PCS, HCPCS, and CPT-4 codes, as well as secondary diagnoses and procedures. The auditor assesses the use and quality of coding queries, monitors coder trends for educational opportunities, and supports the CCDI department as a Subject Matter Expert (SME) in coding reimbursement and auditing. A significant portion of the role involves data capture and reporting, including the accurate utilization of audit databases, preparation of detailed reports using software like Excel, and identification of opportunities for process improvement. The position also plays a role in the fiscal management of coding resources by meeting team KPI goals, verifying charges and reimbursement, and resolving IT issues. Professional accountability includes adhering to ethical coding standards, maintaining certifications, and staying knowledgeable about regulatory requirements. This position manages people.

Requirements

Associate's Degree Health Information or related field Req
5 Years Years of acute care and/or relevant experience may be substituted in lieu of degree Req
5 Years Acute care inpatient or CPT surgical level coding Req
RHIA - Registered Health Information Administrator 12 Months Req
RHIT - Registered Health Information Technician 12 Months Req
CCS - Certified Coding Specialist 12 Months Req
COC - Certified Outpatient Coder 12 Months Req
Thorough knowledge of ICD 10-CM, PCS and CPT.
Expert in coding convention/automated encoder (knowledge management of NCCI/OCE billing edits).
Practiced in APC and DRG methodologies and regulatory/payer requirements associated with coding.
Ability to interpret and apply coding and regulatory policy to coding practice and record review process.
Must demonstrate efficient time management and organizational skills; clear and concise oral and written communication skills, strong decision making and problem-solving skills are required.

Nice To Haves

Bachelor's Degree Health Information or related field Pref
1 Year Performing coding and documentation audits Pref
Proficiency in software applications (Excel, Word, PPT, SharePoint, Optum CAC, EPIC) and strong data analysis capability and report composition skills is preferred.

Responsibilities

Validates accuracy of assigned ICD-10-CM and PCS codes and DRG grouping
Validates accuracy of assigned HCPCS, CPT-4 and APC grouping secondary diagnoses and procedures.
Validates the assignment of medically necessity narrative diagnoses as required for specific inpatient medical coverage policies including communication with clinical and/or physician.
Assesses the use and quality of coding queries; reports non-compliance with regulatory and/or department standards.
Monitors coder trends and patterns for education opportunities and/or physician and clinical documentation improvement needs.
Maintains DRG change accuracy of 95%.
Supports CCDI department as Coding Reimbursement & Audit team as Subject Matter Experts (SME) in ICD-10-CM and PCS reporting.
Utilizes departmental audit databases and/or software accurately to ensure audit data is robust and accurate to relay coded data accuracy
Prepares detailed reports by use of excel, excel pivot tables and/or other software as provided; continuously improves on trend identification and capture for optimal reporting
Provides ad hoc and/or additional data to support identification and feedback of opportunities to leadership
Identifies and reports opportunities for process improvement
Captures meeting minutes, follow ups and action plans as required according to audit scope.
Recommends refinement and implementation of methods and procedures used to for coder and physician education and training; creates and shares tips and audit team education to support department collaboration and efficiency
Provides adequate data to facilitate the identification of development of actions
Updates and develops team policies and procedures to optimize processes; recommends practices to maintain standards for correct coding.
Consistently meets team KPI goals to support department and system revenue and quality targets.
Responds to changes in workload/volumes with team and/or lead communicates when to ensure coverage adjusts for optimal coverage volumes
Verifies, researches and/or and review codes, charges and reimbursement on patient accounts and denials or for service lines.
Completes productivity tracking daily; responds and initiates Analyst to Analyst discussions to team ensure decisions are collaborative, consistent and accurate.
Resolves ITS issues impacting work by collaborative communication with team, vendor, informaticist and/or IT as required.
Maintains frequent and regular contact with manager and seeks consultation and guidance when appropriate.
Participates in personal annual performance evaluation, providing opportunity for growth and development.
Participates in committee work and cross functional teams as determined by department leadership
Consistently abides by the Standards of Ethical Coding as set by AHIMA and adheres to Official Coding Guidelines; reviews and applies the directives published in the AHA Coding Clinic and CPT Assistant publication and other approved resources.
Maintains certification with CE credits. Pursues knowledge and participation in HFMA, AAPC and AHIMA organizations.
Maintains knowledge of regulatory requirements, payer coverage determinations; demonstrates initiative in identifying areas requiring further research.
Completes of all department and hospital required training and education according to schedule; maintains all required certification(s) and continuing education requirements.
Meets audit, project and task deadlines.
Serves as a subject matter expert in expert in areas of documentation, ICD-10-CM and PCS coding with proficiency in CPT-4, HCPCS and modifier assignment.