Coding Quality Auditor

Hackensack Meridian Health•Neptune City, NJ

About The Position

The Coding Quality Auditor is responsible for monitoring compliance with applicable clinical documentation to support coding and billing regulations to insure appropriate reimbursement and to support public reporting and various initiatives as directed by Hackensack Meridian Health (HMH) Network.

Requirements

Associate's degree or higher or equivalent years of coding experience (2-4 years).
Minimum of 5 years of inpatient coding experience in a complex healthcare environment.
Minimum 2 years of quality improvement audit.
Experience and thorough knowledge of ICD-10 and DRG methodologies.
Knowledge of data reporting requirements and proficiency in computer skills.
Extensive knowledge in data collection and clinical coding reviews.
Excellent written, verbal, and interpersonal communication skills.
Proficient computer skills including but not limited to Microsoft Office and Google Suite platforms.
Certified Coding Specialist.

Responsibilities

Reviews Diagnosis Related Group (DRG) assignment for selected Medicare/Medicaid inpatients, Hospital-acquired condition (HAC), Patient Safety Indicators (PSI) and Healthgrade target diagnoses, mortalities and dual diagnosis (dx) for principal diagnosis (Pdx) for the purpose of reimbursement, research and statistics in compliance with federal regulations according to ICD-10 coding classification systems.
Addressing all edits, including but not limited to nosology, Exihauser, PSI, HAC, and others as needed based on quality indicator.
Analyzes physician documentation in the medical record for clinical correlation for coding accuracy and queries physicians when code assignments are not straightforward or documentation in the medical record is inadequate, ambiguous, or unclear for coding purposes.
Provides guidance on any changes made during their review to the Inpatient Coders by furnishing input as necessary in addition to education regarding applicable coding clinics or coding guidelines.
Apply reason/tracking code and rationale (if needed) in 3M as needed for DRG mismatches on Clinical Documentation Improvement (CDI) reviewed cases.
Provides guidance to the Clinical Documentation Specialists by furnishing input as necessary in addition to education regarding applicable coding clinics or coding guidelines.
Performs data analysis and statistical gathering on a monthly basis with regards to DRG, Public Reporting, HAC compliance which is then presented to the Chief Compliance Officer.
Makes recommendations on documentation improvement needs within the facility to improve patient care.
Applies Present On Admission (POA) indicators on all inpatient charts.
Brings identified concerns to the supervisor or department manager for resolution.
Enters data such as diagnosis and procedure codes and charts abstracted information for DRG assignments into the 3M coding computer system.
Assists and provides feedback to the Inpatient HIM Supervisor and Inpatient Coding Manager with education sessions for coding staff.
Assists in chart completion to ensure Discharged not final billed (DNFB) goals are met.
Assists in special projects when applicable such as in-house audits or audits pertaining to contract coders.
Creates spreadsheets and summary of findings.
Attends monthly coding in-services provided by the Inpatient Coding Educator.
Assists the coding staff when needed.
Keeps abreast of coding guidelines and reimbursement reporting requirements, new technology and procedures as well as Centers for Medicare & Medicaid Services (CMS) approved clinical trials.
Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association and adheres to official coding guidelines.
Other duties and/or projects as assigned.
Adheres to HMH Organizational competencies and standards of behavior.