Coding Auditor

  • Requisition ID: 167800
  • Department: 100736 Health Information Mgt
  • Schedule: Full Time - Eligible for Benefits
  • Shift: Day
  • Category: Clerical & Administrative Support

Position Purpose

This position is responsible for the coordination of quality audits for coding staff and/or Renown providers. In addition, this position is responsible for auditing as part of the Coding Teams and the reporting of audit results to Leadership, Compliance and other Departmental Leadership when applicable. The emphasis of this position is to coordinate all aspects of audit entities, including outside request for compliance and billing, including and not limited to RAC and/or other auditing programs requests.

 

This position is responsible in keeping abreast of continual changes in coding and billing guidelines and compliance related to reimbursement within federal and State regulations. This incumbent is to have expert knowledge of accurately assigning ICD-10-CM diagnostic, procedure codes and E/M levels for all aspects of facility or professional coding. This list is to include Acute Inpatient/Outpatient, Level II Trauma, Rehab Facility, Home Health, Hospice, Ambulatory and hospital-based outpatient areas. ICD-10-CM/PCS, CPT and E/M code assignments must be consistent with CMS Official Guidelines, regulatory agencies and hospital specific bylaws and guidelines.

 

 

 

Nature and Scope

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.

 

 

 

Disclaimer

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.

 

 

 

Minimum Qualifications
Requirements - Required and/or Preferred

Name

Description

Education:

Must have working-level knowledge of the English language, including reading, writing and speaking English. Bachelor's Degree in Health Information Management is preferred.

Experience:

A minimum of 10 or more years of progressively responsible and advanced experience in healthcare coding with a combined 2 years or more of auditing experience in either facility of professional services coding. Experience in all patient types as well as experience and knowledge of needed compliance criteria for all facility types is required.

License(s):

None

Certification(s):

AAPC, AHIMA or Certified Coding credential (excludes apprenticeship classification)

Computer / Typing:

Must possess, or be able to obtain within 90 days, the computers skills necessary to complete online learning requirements for job-specific competencies, access online forms and policies, complete online benefits enrollment, etc.

 

 

Benefits

Renown Health exists to make a genuine difference in the health and well-being of the people and communities we serve. And it is through your passion that this mission is made real every day. The relationship with employees is the foundation for success as we proceed with our strategic direction. We strive to build upon this solid partnership by offering a comprehensive and competitive benefits package that meets the diverse needs of employees and their family members.

With my CAREER Rewards there's peace of mind in knowing that Renown Health is also fighting for the most important things in your life - family, finances and future. Navigate options and make sure you are getting the most value from your Nursing career with us.

  • Icon- Edu Assistance@1x

    Education Assistance

  • Icon - PTO@1x

    Paid Time Off

  • Icon - 401@1x

    401(k) Company Match

  • Icon - Flexible Env@1x

    Flexibile Work Environment

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