The major challenge of this position is to coordinate the coding staff auditing schedules for quality and proficiency to ensure compliance of Coding/Auditing, Coding and documentation quality, and that accurate reimbursement is being met with quality coding standards. This position is accountable for auditing information coded from provider documentation and patient medical records within the designated time frames in order to expedite the billing process ensure accurate reimbursement for services rendered and to promote compliance.
All findings obtained in the auditing arena must be documented and reported to Coding Leadership.
This position has access to proprietary information and has contact with other departments, which mandates high standards of professionalism, communication, performance, and respect for confidentiality. This position is challenged to be aware of the continual changes in Federal and State regulations.
This person must be able to identify and resolve problems, set goals and priorities, and represent the department in a professional manner as well as in the absence of Leadership, as assigned.
High standards of performance, courteousness, diplomacy, and respect for confidentiality are essential.
Specific Job Responsibilities by section include;
Coding Auditor (Facility):
This list is to include but is not limited to auditing, educating and escalating results/trends to Coding Leadership; Acute Inpatient/Outpatient, Level II Trauma, Inpatient Rehab, Home Health, Hospice and hospital-based outpatient departments. Feedback and correction of ICD-10-CM/PCS, CPT codes and DRG assignments must be in alignment with departmental standards of work, facility policy, CMS Official Guidelines and regulatory agencies.
Coding Auditor (Professional Services):
This list is to include but is not limited to auditing, educating and escalating results/trends to Coding Leadership; Renown Primary Care and Specialty Care Groups, Acute Inpatient/Outpatient, Trauma and Inpatient Rehab. Feedback and correction to coders and Renown providers of ICD-10-CM, CPT, HCPCS, E/M code assignments and modifiers must align with departmental standards of work, facility policy, CMS Official Guidelines and regulatory agencies.
The foregoing description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills and efforts or work conditions associated with the job. It is intended to be an accurate reflection of the general nature and level of the job.
Incumbent must have skill set to:
• Address appeals and review needed information for insurance denials to facilitate expedient resolution and reimbursement.
• Participates in mandated Medical Record Review processes.
• Interprets and applies American Hospital Association (AHA) Official Coding Guidelines to articulate and support appropriate principal, secondary diagnoses and procedures.
• Knowledge of discharge disposition and reimbursement outcomes.
Other responsibilities include:
• Adherence to Health Information Management (HIM) Coding policies.
• Adherence to The Joint Commission (TJC) and other third party documentation guidelines in an effort to continually improve coding quality and accuracy.
• Responsibility for maintaining coding certification and referencing current ICD-10 coding guidelines and regulatory changes.
• Participates in performance improvement initiatives as assigned.
The incumbent must consistently meet or exceed productivity and quality standards as defined by the HIM Coding Leadership.
Telecommuting is allowed with approval from HIM Management.
KNOWLEDGE, SKILLS & ABILITIES
1. Expert knowledge and specific details of coding conventions and use of coding nomenclature consistent with CMS’ Official Guidelines for Coding and Reporting ICD-10-CM coding.
2. Incumbent must have thorough knowledge of Anatomy and Physiology of the human body, Disease Pathology, and Medical Terminology in order to understand the etiology, pathology, symptoms, signs, diagnostic studies, treatment modalities, and prognosis of diseases and procedures performed.
3. Accurate translation of written diagnostic descriptions to appropriately and accurately assign ICD-10-CM diagnostic codes and procedural codes to obtain optimal reimbursement from all payer types, including Medicare/Medicaid, private and commercial insurance payers.
5. Knowledge of clinical content standards.
6. Ability and knowledge of the appeal process to ensure accurate reimbursement.
This position does not provide patient care.