Coding Auditor

The Methodist Hospitals•Merrillville, IN

About The Position

Responsible for ensuring accuracy and quality coding assignments for all records requiring DRG and/or APC coding; ensures optimal and timely reimbursement. Performs comprehensive pre-billing coding audits, through the use of eValuator, to ensure claims are accurately coded and charged in compliance with coding and regulatory standards. Performs comprehensive pre-billing coding data quality reviews on inpatient and/or outpatient records to ensure proper coding guidelines have been followed and appropriate DRG (MS/APR) or APC assignments have been made for appropriate reimbursement. Responsible for completion of reviews within 72 hrs of import date to include new reviews of up to or exceeding 12 to 15 per day for inpatients and/or completion of reviews within 48 hrs of import date including up to or exceeding 50 per day for outpatient accounts. Maintains an audit response turnaround time of 24 to 48 hours, with the exception of weekends. Reviews abstracted data to ensure quality of required data elements (facility specific elements) including appropriate discharge disposition. Responsible for maintaining coded data quality through ongoing quality review and assessment of outpatient and/or inpatient 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 staff adheres to ICD 10-CM/PCS, CPT/HCPCS coding guidelines and policies. Maintains working knowledge of CMS (Medicare and Medicaid) regulations, Local Coverage Determinations (LCD), National Coverage determination (NCD) and National Correct Coding Initiatives (NCCI). Communicates quality audit results and recommendations to management in a clear and concise manner Performs ad hoc quality reviews and audits as requested by management. Participates in team meetings with coding staff to discuss coding problems, changes, or issues. Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association and monitors coding staff for violations and reports to leadership when areas of concern are identified Performs other duties as needed and/or assigned.

Requirements

Demonstrates working knowledge of the English language, verbal and written.
Demonstrates basic understanding of coding guidelines.
Requires course work in/knowledge of medical terminology, anatomy and physiology, pathophysiology in order to interpret data on patient documentation.
Working knowledge of all areas of adult medicine.
Demonstrates strong interpersonal and communication skills necessary to interact effectively with all internal and external customers, verbally and in writing, as required.
Requires strong organizational and analytical skills in order to prepare and maintain various documentation/reports.
Demonstrates the knowledge and understanding of intensity of service, severity of illness, opportunities for intervention, planned course of treatment/procedures, care needs, and outcome goals.
Requires excellent observation skills, analytical thinking, and problem solving ability.
Requires strong critical thinking skills, ability to assess/evaluate/teach.

Nice To Haves

Prior history as Clinical Documentation Specialist role, leadership skills, helpful.
Inpatient Coding/Clinical documentation review is Preferred.
3 yrs of Coding/Clinical documentation Improvement is Preferred.

Responsibilities

Performs comprehensive pre-billing coding audits, through the use of eValuator, to ensure claims are accurately coded and charged in compliance with coding and regulatory standards.
Performs comprehensive pre-billing coding data quality reviews on inpatient and/or outpatient records to ensure proper coding guidelines have been followed and appropriate DRG (MS/APR) or APC assignments have been made for appropriate reimbursement.
Responsible for completion of reviews within 72 hrs of import date to include new reviews of up to or exceeding 12 to 15 per day for inpatients and/or completion of reviews within 48 hrs of import date including up to or exceeding 50 per day for outpatient accounts.
Maintains an audit response turnaround time of 24 to 48 hours, with the exception of weekends.
Reviews abstracted data to ensure quality of required data elements (facility specific elements) including appropriate discharge disposition.
Responsible for maintaining coded data quality through ongoing quality review and assessment of outpatient and/or inpatient 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 staff adheres to ICD 10-CM/PCS, CPT/HCPCS coding guidelines and policies.
Maintains working knowledge of CMS (Medicare and Medicaid) regulations, Local Coverage Determinations (LCD), National Coverage determination (NCD) and National Correct Coding Initiatives (NCCI).
Communicates quality audit results and recommendations to management in a clear and concise manner
Performs ad hoc quality reviews and audits as requested by management.
Participates in team meetings with coding staff to discuss coding problems, changes, or issues.
Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association and monitors coding staff for violations and reports to leadership when areas of concern are identified
Performs other duties as needed and/or assigned.