Inpatient Coding Auditor- Remote

Gainwell Technologies LLC

29d•Remote

About The Position

Gainwell is seeking an Inpatient Coding Auditor, Senior Associate, to join their team. This role is for individuals with strong medical minds capable of creating powerful solutions for healthcare challenges. While the company operates with urgency, it offers flexible hours and values work-life balance, continuous learning, and career development. The Senior Associate will be responsible for performing coding reviews of inpatient medical records and other documentation to determine correct coding based on contract-specific methodologies. This involves using proprietary systems to audit records, accurately document findings, and provide policy/regulatory support. The ideal candidate will have an extensive background in facility-based inpatient coding and/or outpatient coding edits, with a high level of understanding of reimbursement guidelines, specifically MS-DRG, AP-DRG, APR-DRG, ASC, and APC payment systems.

Requirements

One or more active professional credentials through AHIMA or AAPC: CPC, CCS, COC, RHIA, RHIT; required
2+ years experience of inpatient medical record coding and/or auditing; required
Demonstrated proficiency in medical record auditing and ICD-10 CM, ICD-10-PCS, APC, ASC, HCPCS, and CPT coding methodology.
Demonstrates a thorough understanding of the APR-DRG, AP-DRG, and MS-DRG.
Demonstrated proficiency in computer skills and typing, i.e., Microsoft Windows, Outlook, Excel, Word, PowerPoint, Internet browsers and in virtual meeting tools i.e., Microsoft Teams, Zoom, etc.

Responsibilities

Performs audits of inpatient medical record documentation to determine the accuracy of principal and secondary diagnosis (including MCC & CC) and procedure codes.
Validates the assignment and sequencing of ICD-10 codes, discharge status, Hospital Acquired Conditions, POA assignment and DRG assignment.
Adheres to official coding guidelines, coding clinics and regulatory guidelines and mandates.
Draws on advanced ICD-10 coding expertise to substantiate conclusions.
Utilizes proprietary auditing systems with a high level of proficiency to document audit determinations and rationale.
Consistently achieves productivity and quality performance standards established by management.
Actively cross-trains to perform reviews of multiple claim types to provide a flexible workforce to meet client needs.
Assists management with training new Coding Auditors to include daily monitoring, mentoring, feedback and education.
Maintains current knowledge of coding guidelines and successfully completes required CEUs to maintain coding certification.
Responsible for attending training and scheduled meetings to enhance skills and working knowledge of clinical policies, procedures, rules, and regulations.