What are the responsibilities and job description for the Coding Quality Auditor position at Sarasota Memorial Health Care System?
Optimizes prospective payment reimbursement and facilitates data quality by creating consistency and efficiency in physician documentation, code assignment, data collection, and claims processing. Responsible for working with physicians, coders, ancillary department staff, CDI, and other allied health professionals to improve documentation of patient care and to appropriately assign codes and/or determine charges to support those services. Performs retrospective random and focused audits of coding cases to ensure accurate code application and overall coding quality. Performs pre-bill compliance audits to ensure accurate code assignment, application of coding guidelines, and compliance with external regulatory and accreditation requirements. Identifies solutions to improve the overall data quality of the health records and to assure that appropriate reimbursement is obtained for services provided.
Required Qualifications:
For APC/DRG Auditor: - Require certification by American Health Information Management Association (AHIMA) as a Certified Coding Specialist (CCS) or certification by American Academy of Professional Coders (AAPC) as a Certified Inpatient Coder (CIC) or Certified Outpatient Coder (COC). - Require certification by AHIMA as a Registered Health Information Technician (RHIT)* or Bachelor's level degree. *In lieu of certification, must be currently enrolled in an accredited HIM program. Must successfully pass the certification exam within six (6) months of program completion. For Senior APC/DRG Auditor: - Require certification by AHIMA as a Certified Coding Specialist (CCS) or certification by AAPC as a Certified Inpatient Coder (CIC) or Certified Outpatient Coder (COC). - Require certification by AHIMA as a Registered Health Information Technician (RHIT) or Registered Health Information Administrator (RHIA). - Require a Bachelor's degree in related field.
For APC/DRG Auditor: - Require three (3) years of inpatient or outpatient coding experience. For Senior APC/DRG Auditor: - Require five (5) years of inpatient or outpatient coding experience and three (3) years of coding auditing experience.
Preferred Qualifications:
- Prefer past auditing experience or strong training background in coding and reimbursement.
- Prefer comprehensive knowledge of the Prospective Payment System and other regulatory requirements and payment systems.
Mandatory Education:
HS EQ: High School Diploma, GED or Certificate
Preferred Education:
Required License and Certs:
Preferred License and Certs:
