Coding Inpatient Auditor

AdventHealth•Orlando, FL

1d•Remote

About The Position

Performs quality reviews on coded records to validate ICD-10, ICD-10-PCS, MS-DRG, APR-DRGs, and overall coding accuracy retrospectively and concurrently. Provides continuing education to individual coders and the coding staff concerning changes in the coding and reimbursement system and any weaknesses identified during the coding validation reviews. Reviews, analyzes, and interprets clinical documentation, seeking clarification from the physician when discrepancies exist, and effectively communicates with physicians and allied health personnel. Assists with writing compelling appeals to all DRG denials from outside agencies, referencing Official Coding Guidelines and Coding Clinic advice as appropriate to defend the DRG assignment and protect the organization’s reimbursement. Serves as a resource to other departments in the Revenue Cycle to ensure business continuity and optimal revenue cycle management. Uses critical thinking and sound judgment in decision-making, balancing reimbursement considerations with regulatory compliance. Prepares statistical reports conveying the individual and overall accuracy of coding. Assumes personal responsibility for professional growth, development, and continuing education to maintain a high level of proficiency. Maintains the confidentiality of employees, patients, administrative, and medical staff information with no infractions. Works with other Coding team members to keep coding within two days of discharge and hospital coding days within three days, maintaining a median coding turn-around time of 3 days or less. Meets and maintains established productivity standards and a 98% or better in coding accuracy. Performs concurrent coding as assigned. Other duties as assigned.

Requirements

Strong IP coding skills
Understanding of code edits
Expansive knowledge of Medicare DRGs, APR-DRG, coding guidelines and guidance materials, and reimbursement systems.
Excellent interpersonal, verbal, and written communication skills; proficient in and demonstrate excellent physician relations.
Computer skills, including Microsoft Office and Encoder software.
Self-motivated and able to work independently in a remote setting.
Critical thinking and problem-solving skills
Comprehensive knowledge of coding functions, rules, and guidelines related to DRG assignments.
Strong ability to organize/triage work and manage multiple priorities simultaneously with little supervision.
Possesses knowledge about risk adjustment and publicly reported hospital data.
Possesses knowledge about patient safety indicators, SOI/ROM, and the importance of hospital publicly reported data, value-based purchasing, and how coding impacts these measures.
Exhaustive knowledge of inpatient coding and working knowledge of ICD-10-CM, ICD-10-PCS, MSDRG’s, APRDRG’s, HAC’s, POA indicators, CMI and all regulatory compliance requirements.
Excellent computer skills with a knowledge of Excel spreadsheets.
High School Grad or Equiv
5+ years of inpatient of outpatient coding or auditing experience
Registered Health Information Administrator (RHIA) OR Registered Health Information Technician (RHIT) OR Certified Coding Specialist (CCS) OR Certified Professional Coder (CPC)

Nice To Haves

Experience with Epic a plus
Optum experience a plus!
Comprehensive experience with cases requiring more complex coding skills, such as advanced cardiovascular, cardiothoracic, neurological, and orthopedic surgical procedures, extended or prolonged length of stays (> 100 days), BMT and other solid organ transplantations, ECMO, cutting-edge surgical advancements that are considered new and innovative, procedures that may be considered experimental or research-based, and other complicated treatments or procedures provided in a quaternary care facility.
Technical/Vocational School
in a related field of study or equivalent technical experience

Responsibilities

Performs quality reviews on coded records to validate ICD-10, ICD-10-PCS, MS-DRG, APR-DRGs, and overall coding accuracy retrospectively and concurrently.
Provides continuing education to individual coders and the coding staff concerning changes in the coding and reimbursement system and any weaknesses identified during the coding validation reviews.
Reviews, analyzes, and interprets clinical documentation, seeking clarification from the physician when discrepancies exist, and effectively communicates with physicians and allied health personnel.
Assists with writing compelling appeals to all DRG denials from outside agencies, referencing Official Coding Guidelines and Coding Clinic advice as appropriate to defend the DRG assignment and protect the organization’s reimbursement.
Serves as a resource to other departments in the Revenue Cycle to ensure business continuity and optimal revenue cycle management.
Uses critical thinking and sound judgment in decision-making, balancing reimbursement considerations with regulatory compliance.
Prepares statistical reports conveying the individual and overall accuracy of coding.
Assumes personal responsibility for professional growth, development, and continuing education to maintain a high level of proficiency.
Maintains the confidentiality of employees, patients, administrative, and medical staff information with no infractions.
Works with other Coding team members to keep coding within two days of discharge and hospital coding days within three days, maintaining a median coding turn-around time of 3 days or less.
Meets and maintains established productivity standards and a 98% or better in coding accuracy.
Performs concurrent coding as assigned.
Other duties as assigned.