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This position is responsible for ongoing quality review and assessment of coded hospital data. Performs audits on the accuracy of ICD-10, CPT-4, MS-DRG, APR-DRG and APC assignments. Performs review of claims denied for coding, documentation, and clinical validation, and formulates and submits letters of appeal. Prepares reports for management review and identifies trends. Conducts focused retrospective audits and regular scheduled audits of individual coders. Manages all audits conducted by internal and external entities and responds to requests for code verification. In conjunction with the Coding Supervisors and Coding Manager, contributes to the development of educational and training opportunities for staff.
