Inpatient Coding Data Quality Auditor/Educator

University Hospital, Newark NJ•Newark, NJ

7d•$98,288 - $142,009•Onsite

About The Position

The primary purpose of the Inpatient Coding Data Quality Auditor/Educator is to ensure the consistent processing of claims and collection of data to optimize DRG reimbursement and produce quality data that accurately reflects the severity and intensity of hospital inpatient services. Audits inpatient coded records, provides continuing education of all inpatient coding staff and facilitates the inpatient coding work flow.

Requirements

Bachelor’s degree in Health Information Management or a related field required
CCS certification required
If not CCS certified, must obtain CCS certification from AHIMA within 60 days of hire or within 60 days of the next available exam
Minimum of 3 years of hospital inpatient coding experience
Experience with ICD-9 and ICD-10 diagnosis and procedure coding
Experience with DRG assignment
Knowledge of complex services including surgical, transplant, trauma, neurosurgery, OB/GYN, and neonatology
Knowledge of medical terminology, anatomy and physiology, and disease processes required
Knowledge of Coding Clinic, POA, and query guidelines required
Knowledge of CMS, Medicaid, and third-party payer coding, billing, and compliance regulations required
Ability to manage multiple and changing priorities
Must be detail-oriented, accurate, and organized
Ability to work independently
Strong verbal and written communication skills
Additional related experience may be substituted for the degree requirement on a year-for-year basis

Nice To Haves

RHIA or RHIT certification preferred
Experience in a tertiary care or teaching hospital environment preferred
Experience with encoder systems (e.g., Clintegrity 360) preferred
Experience with Epic electronic health record preferred

Responsibilities

Performs daily data quality reviews on inpatient records to validate ICD-10 diagnosis and procedure codes
Ensures accuracy, proper sequencing, and adherence to coding guidelines on all cases
Reviews cases identified as OIG-focused DRGs, transfer DRGs, and other target areas as needed
Verifies the accuracy and appropriateness of the selected DRG
Communicates coding corrections to coders and explains the rationale for educational purposes
Utilizes audit tracking tools to identify coding error types by coder
Prepares written rebuttals for DRG reassignments or appeals, when requested
Provides supporting documentation to third-party payers to ensure compliance and accurate reimbursement
Reviews physician queries for appropriateness and follows up to ensure timely responses
Adheres to AHIMA Standards of Ethical Coding
Monitors coding staff for potential violations and reports concerns to the Manager
Continuously evaluates clinical documentation quality
Identifies incomplete or inconsistent documentation impacting code selection, DRG grouping, and reimbursement
Escalates documentation concerns as needed