What are the responsibilities and job description for the Coding Auditor Compliance position at Northwest Health System Springdale?
Job Summary
The Compliance Coding Auditor reviews and audits hospital claims to ensure compliant coding, identifying potential risks and opportunities for improvement. This role may also involve developing and delivering education, responding to denials, collaborating with the Clinical Documentation Improvement (CDI) team on specific scenarios, and contributing to initiatives focused on ensuring complete and accurate coding. The auditor is responsible for making independent decisions regarding accurate ICD-10-CM, ICD-10-PCS, and CPT/HCPCS code assignments, which directly impact CHS's reimbursement potential while adhering to compliant coding standards and corporate billing policies. This position applies only to facilities where Corporate Compliance does not provide audit support.
Essential Functions
- Performs pre- or post-bill reviews based on scope of functional responsibility.
- Ensures corrections are appropriately rebilled to remedy over/under reimbursement and data quality issues.
- Collaborates with corporate compliance and coding peers.
- Performs research using approved sources in support of compliant coding to regulatory guidelines.
- Follows established procedures in documenting and communicating findings.
- Attends coding education as scheduled and necessary.
- Performs other duties as assigned.
- Complies with all policies and standards.
Qualifications
- H.S. Diploma or GED required
- Other Successful completion of a Medical Coding Program preferred
- Associate Degree Health Information Management or related field preferred
- 3-5 years Acute care inpatient coding experience for all inpatient medical and surgical patient types required or
- 3-5 years Hosptial outpatient coding experience for all outpatient medical and surgical patient types required
- 1-2 years Hospital quality audit experience preferred
Knowledge, Skills and Abilities
- High degree of accuracy.
- Must preserve confidentiality of health information.
- Strong communication and organizational skills.
- Excellent written and verbal communication skills.
