CODING AUDITOR

Methodist Hospitals • Merrillville, IN

261d • Remote

About The Position

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.

Requirements

• 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.

Nice To Haves

• 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.

Responsibilities

• 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.

Benefits

• Methodist Hospitals strives for excellence and insists on high standards of conduct and performance.

What This Job Offers

• Industry: Hospitals
• Education Level: Associate degree