The Coding Auditor/Denial Analyst accurately and efficiently audits and analyzes medical records, charge sheets and reports to ensure in the coordination of proper coding/billing. Serves as an internal auditor and educates on findings. Manages all aspects of the denial process including appeal and collaboration with outside sources as well as internal resources to research and respond to various denial cases. Supports the integrity of the coding and accurate reimbursement, quality scores, benchmark data and statistical reporting. Develops and maintains coding related policies and procedures. Works as a team member to process patient health information that supports patient care, legal, statistical, educational, and financial (reimbursement) requirements. Maintains patient confidentiality at all times. Utilizes manual and electronic information systems to achieve timely and accurate medical record documentation review and analysis.

Job Duties:

• Provide coding audit services for all inpatient and outpatient records to include ICD-10-CM/PCS, DRG, ROM/SOI/APR-DRG, CPT/APC, E&M coding and assignment and abstracting reflective of clinical documentation. Ability to successfully perform coding quality review to validate correct coding and charge capture. Provide feedback and education to various audiences, prepare data procedures, notify management when there is a compliance concern or incident.
• Implement education guidance in anticipation of organizational needs and/or in response to regulations and annual updates. Create standardized education resources regarding coding and documentation best practices.
• Manage denial processing, working with various hospital departments and Providers offices. Communication with various department staff, office staff, payors, Providers, and third-party contractors to ensure all information is accounted for, appropriate and timely.
• Ability to research and validate insurance payor policies to confirm appropriate coding and documentation needs. Analyze coding issues and questions from both a compliance and reimbursement perspective.
• Performs regular and active coding of various work types.

Shift Details:

Hours: Full Time, 40 hours/week

Shift: Day Shift

Qualifications:

• Associate degree
• Successful completion of an American Health Information Management Association’s (AHIMA) accredited program for health information technicians or health information administrators preferred or a related field.
• Successful completion of an American Health Information Management Association (AHIMA) recognized national examination leading to the achievement of an AHIMA professional credential of Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Coding Auditor and Revenue integrity Analyst (CCS), or Certified Coding Associate (CCA) required.
• Prior revenue cycle experience preferred.
• Office and Hospital coding experience preferred.
• Auditing experience preferred.