Medical coding auditor

General Summary:

Systematically reviews medical coding for all patient types to determine that the coding for all diagnosis and procedures, especially those in which reimbursement is DRG dependent, are submitted in a timely and accurate manner. Routinely researches, clarifies and resolves coding problems.

Responsibilities:

1. Manages and oversees the entire coding process for Bayhealth inpatient and outpatient.
2. Manages the E/M level code assignment for the Emergency Departments.
3. Randomly reviews accounts to ensure the most appropriate MS-DRG for inpatients, APGs for Day Surgery and the most appropriate diagnosis/procedure codes on outpatients are assigned and the most appropriate E/M level.
4. Performs daily monitoring of essential Queues for timely coding of records.
5. Demonstrates knowledge of DRG payor issues, documentation opportunities, clinical documentation requirements and coding requirements.
6. Performs audits of coding staff to a. Evaluate documentation for assigned principal diagnosis, pertinent secondary diagnosis and procedures for accurate DRG assignment, risk of mortality and severity of illness b. Evaluate physician queries created for coding clarification.
7. Evaluates and interprets statistical and narrative analysis reports of department services to ensure appropriate and timely coding.
8. Manages Health Information Management coding staff.
9. Maintains accurate budget data and monitors coding staff productivity.
10. Develops and provides education to physicians and others to improve coding outcomes.
11. Performs liaison duties with EPIC to evaluate software updates and assists with testing of software changes.
12. All other duties as assigned within the scope and range of job responsibilities.

Required Education, Credential(s) and Experience:

• Education: Associate Degree; Related field; Or two (2) years of additional experience may be considered in lieu of a degree.
• Credential(s): Certified Coding Specialist
• Experience: Required: 5 years’ experience in an acute care hospital setting, 5 years coding experience

Preferred Education, Credential(s) and Experience:

• Education: Bachelor Degree Health Care or Health Information Technology or related field.
• Credential(s):
• Experience: Preferred: 5 years supervisory experience in an acute care hospital setting, 10 years coding experience