Coding Auditor Senior Facility

McLaren Health Care • Grand Blanc, MI

1d

About The Position

Responsible for providing ongoing coding and documentation education to physicians, coders, ancillary department staff, clinical documentation improvement (CDI), and other allied health professionals. Education may be quarterly, annual, or ad hoc and is intended to improve patient-care documentation and support appropriate code assignment and charge determination. The role performs coding quality assurance and compliance audits, supports coding specialists and auditors, and contributes to clinical validation initiatives.

Requirements

• High school diploma.
• Five years of coding experience.
• Certification in at least one of the following: AHIMA (such as RHIA, RHIT, CCS); AAPC (such as CPC, CCC, COC, CIC, CHONC, etc.); or AMAC (such as ROCC).
• Three years of experience conducting medical coding audits and quality performance measures.

Nice To Haves

• Associate degree in HIT, Applied Science, Liberal Arts, or another related healthcare field.
• AAPC specialty certification, such as CIRCC or CPMA.

Responsibilities

• Complete quality assurance audits of inpatient and outpatient coding specialists, including onboarding audits and training for newly hired coding specialists, to validate accurate abstraction into medical record systems and compliance with coding guidelines and directives.
• Validate Present on Admission (POA) indicators according to guidelines and identify missing or inappropriate provider queries.
• Use payment methodology to audit outpatient and/or inpatient facility coding and billing, MS-DRG or APC assignment, and OPPS reimbursement methodology; share knowledge with colleagues and clinical team members.
• Support Clinical Validation Initiatives by identifying cases for review and resolution and developing Clinical Validation Guidebook guidance with CDI for complications or diseases identified during Clinical Validation Meetings.
• Serve as an advisor and support to the Auditor.
• Perform retrospective, random, and focused coding-case audits to ensure accurate code application and overall coding quality.
• Perform periodic and ongoing pre-bill compliance audits to ensure accurate code assignment, proper application of coding guidelines, and compliance with external regulatory and accreditation requirements.
• Provide ongoing coding and documentation education to physicians, coders, ancillary department staff, CDI, and other allied health professionals.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: High school or GED