Coding Compliance Auditor - Wailuku HI
About The Position
The HIM Coding Auditor/Trainer coordinates, monitors, and audits documentation and coding for inpatient and/or outpatient services in applicable healthcare settings. Audits evaluate assignment of CPT, ICD-10, ICD-9-CM, and HCPCS codes and clinician documentation to support compliance with regulatory guidelines and internal controls. The work covers internal and contracted practitioners, coders, and facilities. The auditor analyzes findings to identify patterns, trends, or variations in coding and documentation practices and recommends improvements. When needed, the auditor initiates corrective action plans to resolve issues identified through audit and monitoring activities. The role serves as a liaison among HIM staff, Revenue Cycle, practitioners, and other regional departments.
Requirements
- At least four years of inpatient coding experience in an acute care setting, including experience with ICD-10, ICD-9-CM, CPT-4, and HCPCS coding systems, UHDDS definitions, and related documentation requirements.
- Bachelor’s degree in healthcare, health information management, or a related field, or four years of directly related experience.
- Hold one of the following credentials: Certified Coding Specialist (AHIMA), Registered Health Information Administrator (AHIMA), Certified Professional Coder (AAPC), or Registered Health Information Technician (AHIMA).
- Proficient understanding of IPPS/OPPS, MS-DRG, National Correct Coding Initiative edits, ICD-CM Official Guidelines for Coding and Reporting, and Coding Clinic.
- Working knowledge of relevant federal and state regulations, Medicare guidelines, and compliance issues.
- Advanced understanding of medical terminology, pharmacology, anatomy and body systems, physiology, and disease processes.
- Knowledge and skills in data collection, statistical analysis and/or interpretation; communication; problem solving; analysis; project and quality management; systems thinking; group presentations and facilitation; influence; and customer service.
- Knowledge and skills in word processing, spreadsheet, and database PC applications.
- Knowledge and skills in decision-making, interpersonal relations, teamwork, team building and leadership, results orientation, and change management.
Nice To Haves
- Completion of an accredited Health Information Management program.
Responsibilities
- Review and audit coders against federal requirements, current documentation and coding guidelines, internal policies, and applicable laws and regulations.
- Prepare written audit reports identifying deficiencies and recommend corrective measures, such as training, oversight, monitoring, or workflow changes.
- Conduct trend analyses to identify coding-practice variations and case-mix index patterns.
- Develop and deliver education and training based on documentation and coding reviews and findings from RAC and other regulatory audits.
- Compare coding and reimbursement profiles with regional and national norms.
- Review coding claim denials and rejections.
- Receive and investigate reports of compliance violations.
- Communicate audit results to the HIM director and compliance officer.
- Ensure regulation, policy, and guideline changes are communicated to affected personnel.
- Initiate corrective action plans when necessary to address issues identified through auditing and monitoring.
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Career Level
Mid Level
