Coding Compliance Auditor

Job Title:

Coding Auditor - Inpatient/Outpatient

Location: Miramar, Florida

At Memorial Healthcare System, we are dedicated to improving the health, well-being and quality of life for the people entrusted to our care. An unwavering commitment to our service vision is what makes the difference.

Summary:

Responsible for auditing coded inpatient or outpatient medical records applying ICD-10 CM/PCS and/or CPT-4. Reviews Ambulatory Payment Classification (APC), Medicare Severity Diagnosis Related Groups (MSDRG) and All Patients Refined Diagnosis Related Groups (APRDRG) assignment and queries following official coding guidelines and regulatory requirements.

Responsibilities:

• Performs all other duties as assigned.
• Maintains strict adherence to patient confidentiality according to MHS standards and regulatory requirements.
• Holds educational sessions for coding specialists, documentation specialists, and physicians.
• Acts as a liaison for electronic physician query process.
• Utilizes coding audit results to tailor education to increase coding accuracy.
• Assists the coding staff to format compliant queries and assesses for compliance with AHIMA query standards.
• Reports results of coding and query compliance audits to management.
• Maintains thorough knowledge of ICD-10CM/PCS, and CPT coding principles and guidelines; possesses substantial knowledge of MSDRG, APRDRG, APC, and Enhanced Ambulatory Patient Groups (EAPG) classification systems and query guidelines for compliant provider documentation.
• Conducts and reports on electronic medical record audits to verify ICD-10CM/PCS, CPT and APC, MSDRG, and APRDRG coding and grouping accuracy.
• Serves as an expert resource for all coding staff.
• Works closely with inpatient and outpatient coding managers to analyze and resolve claim denials that are rejected by edits from the Revenue Cycle Department.
• Reviews and responds to all external coding denial audits using ICD-10CM/PCS, CPT and APC, MSDRG, and APRDRG audits.
• Coordinates, develops, and implements coder intern education and training. Training will align with AHIMA standards of ethical coding and official coding guidelines.
• Provides feedback based on audit results and tracks coder intern progression throughout the program.

Competencies:

ACCOUNTABILITY, ACCURACY, CUSTOMER SERVICE, EFFECTIVE COMMUNICATION, HUMAN ANATOMY, MEDICAL CODING, MEDICAL TERMINOLOGY (3), RESPONDING TO CHANGE, STANDARDS OF BEHAVIOR

Education and Certification Requirements:

Accredited Program: Health Information Management (Required)

Certified Coding Specialist (CCS) - American Health Information Management Association (AHIMA), Registered Health Information Administrator (RHIA) - American Health Information Management Association (AHIMA), Registered Health Information Technician (RHIT) - State of Florida (FL)

Additional Job Information:

Complexity of Work: Requires critical thinking, decisive judgment, effective written and verbal communication skills. Demonstrates effective time management skills, professional responsibility and fosters teamwork. Able to work with minimal supervision. Must be able to work in a stressful environment and take appropriate action. Ability to accurately assign and sequence ICD-10-CM/PCS and CPT codes to principal diagnosis and procedures, complications and co-morbid conditions to complex inpatient or outpatient encounters such as observation, outpatient surgery and interventional radiology.

Provides guidance to other departmental staff in identifying and resolving coding issues or errors. Proficient in basic computer skills including Microsoft Office applications and utilizing a computerized encoder and electronic medical record systems.

Required Work Experience:

For inpatient coding auditor, three (3) years of inpatient coding experience. For outpatient coding auditor, three (3) years of outpatient coding experience.

Additional Credential Info:

Registered Health Information Administrator (RHIA) or Registered Health Information Technician (RHIT) or Certified Coding Specialist (CCS). For Physician Coding: CPC Certified Professional Coder, HCC - Hierarchical Condition Category Coder, CRC Certified Risk Adjustment Coder, or CPMA Certified Professional Medical Auditor.

Working Conditions and Physical Requirements:

• Bending and Stooping = 40%
• Climbing = 0%
• Keyboard Entry = 60%
• Kneeling = 40%
• Lifting/Carrying Patients 35 Pounds or Greater = 0%
• Lifting or Carrying 0 - 25 lbs Non-Patient = 40%
• Lifting or Carrying 2501 lbs - 75 lbs Non-Patient = 0%
• Lifting or Carrying > 75 lbs Non-Patient = 0%
• Pushing or Pulling 0 - 25 lbs Non-Patient = 40%
• Pushing or Pulling 26 - 75 lbs Non-Patient = 0%
• Pushing or Pulling > 75 lbs Non-Patient = 0%
• Reaching = 40%
• Repetitive Movement Foot/Leg = 0%
• Repetitive Movement Hand/Arm = 60%
• Running = 0%
• Sitting = 60%
• Squatting = 20%
• Standing = 60%
• Audible Speech = 60%
• Hearing Acuity = 60%
• Smelling Acuity = 0%
• Taste Discrimination = 0%
• Depth Perception = 60%
• Distinguish Color = 60%
• Seeing - Far = 60%
• Seeing - Near = 60%
• Bio hazardous Waste = 0%
• Biological Hazards - Respiratory = 0%
• Biological Hazards - Skin or Ingestion = 0%
• Blood and/or Bodily Fluids = 0%
• Communicable Diseases and/or Pathogens = 0%
• Asbestos = 0%
• Cytotoxic Chemicals = 0%
• Dust = 0%
• Gas/Vapors/Fumes = 0%
• Hazardous Chemicals = 0%
• Hazardous Medication = 0%
• Latex = 0%
• Computer Monitor = 60%
• Domestic Animals = 0%
• Extreme Heat/Cold = 0%
• Fire Risk = 0%
• Hazardous Noise = 0%
• Heating Devices = 0%
• Hypoxia = 0%
• Laser/High Intensity Lights = 0%
• Magnetic Fields = 0%
• Moving Mechanical Parts = 0%
• Needles/Sharp Objects = 0%
• Potential Electric Shock = 60%
• Potential for Physical Assault = 0%
• Radiation = 0%
• Sudden Decompression During Flights = 0%
• Unprotected Heights = 0%
• Wet or Slippery Surfaces = 0%

Shift:

Primarily for office workers - not eligible for shift differential

Disclaimer:

This job description is not intended, nor should it be construed to be an exhaustive list of all responsibilities, skills, efforts or working conditions associated with the job. It is intended to indicate the general nature and level of work performed by employees within this classification.