CODING AUDITOR

Methodist Hospitals-posted 7 months ago
Remote • Merrillville, IN
Hospitals
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The Coding Auditor is responsible for ensuring accuracy and quality coding assignments for all records requiring DRG and/or APC coding, ensuring optimal and timely reimbursement. This role involves performing comprehensive pre-billing coding audits and data quality reviews on inpatient and outpatient records, maintaining high standards of coding compliance and quality.

  • Performs comprehensive pre-billing coding audits using eValuator to ensure claims are accurately coded and charged in compliance with coding and regulatory standards.
  • Conducts comprehensive pre-billing coding data quality reviews on inpatient and outpatient records to ensure proper coding guidelines have been followed.
  • Completes reviews within 72 hours of import date for inpatient records and within 48 hours for outpatient accounts, handling up to 15 inpatient and 50 outpatient reviews per day.
  • Maintains an audit response turnaround time of 24 to 48 hours, excluding weekends.
  • Reviews abstracted data to ensure quality of required data elements, including appropriate discharge disposition.
  • Maintains coded data quality through ongoing quality review and assessment of records.
  • Serves as a subject matter expert on ICD 10-CM/PCS and/or CPT/HCPCS coding guidelines and policies.
  • Coaches and educates coding staff to ensure adherence to coding guidelines.
  • Maintains working knowledge of CMS regulations, Local Coverage Determinations, National Coverage Determinations, and National Correct Coding Initiatives.
  • Communicates quality audit results and recommendations to management clearly and concisely.
  • Performs ad hoc quality reviews and audits as requested by management.
  • Participates in team meetings to discuss coding problems, changes, or issues.
  • Abides by the Standards of Ethical Coding and monitors coding staff for violations.
  • Demonstrates working knowledge of the English language, verbal and written.
  • Prior history as Clinical Documentation Specialist is helpful.
  • Demonstrates basic understanding of coding guidelines.
  • Requires coursework in/knowledge of medical terminology, anatomy and physiology, and pathophysiology.
  • Demonstrates strong interpersonal and communication skills.
  • Requires strong organizational and analytical skills.
  • Demonstrates knowledge of intensity of service, severity of illness, and care needs.
  • Requires excellent observation skills, analytical thinking, and problem-solving ability.
  • Requires strong critical thinking skills.
  • Bachelor's Degree in Health Information Technology is preferred.
  • Inpatient Coding/Clinical documentation review experience is preferred.
  • 3 years of Coding/Clinical documentation Improvement experience is preferred.
  • Methodist Hospitals strives for excellence and insists on high standards of conduct and performance.
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