Medical Coding Auditor

Data Quality Auditor

Conducts data quality audits of inpatient admissions and outpatient encounters to validate coding assignment complies with the official coding guidelines as supported by clinical documentation in health records. Validates abstracted data elements that are integral to appropriate payment methodology. Responsible for effectively communicating information and audit findings through presentations, graphs, reports, and educational materials, etc.

Job Responsibilities/Duties:

• Chart Analysis IP, OP Coding Data auditing and validation: Reviews medical records for the determination of accurate assignment of all documented diagnoses and procedures. Adheres to Standards of Ethical Coding (AHIMA). Reviews medical records for the determination of accurate assignment of all documented diagnoses and procedures. Reviews claim to validate abstracted data including but limited to discharge disposition which impacts facility reimbursement and/or MS-DRG assignment. Adheres to Standards of Ethical Coding (AHIMA). Reviews medical records to determine accurate required abstracting elements (facility/client/payer-specific elements) including appropriate discharge disposition
• IP, OP Coding: Reviews medical records for the determination of accurate assignment of all documented ICD-10-CM codes for diagnoses and procedures. Abstracts accurate required data elements (facility/client specific elements) including appropriate discharge disposition.
• Coding: Uses discretion and specialized coding training and experience to accurately assign ICD-10, CPT-4 codes to patient medical records.
• Abstracting: Reviews medical records to determine accurate required abstracting elements (client specific elements) including appropriate discharge disposition.
• Coding Quality: Demonstrates ability to achieve accuracy and consistency in the selection of principal and secondary diagnoses (including MCC & CC) and procedures. Demonstrates ability to achieve accuracy and consistency in abstracting elements defined by SOW.
• Professional Development: Stays current with AHA Official Coding and Reporting Guidelines, CMS and other agency directives for ICD-10-CM and CPT coding. Attends mandatory coding seminars on an annual basis (IPPS and OPPS, ICD-10-CM, and CPT updates) for inpatient and outpatient coding. Quarterly review of AHA Coding Clinic. Attends Quarterly Coding Updates and all coding conference calls
• Create audit schedules and manage workflows to adhere to the audit schedule.
• Develop methods to effectively communicate information through presentations, graphs, reports, educational materials, etc.
• Develop, establish, and review policies and objectives consistent with those of the organization to ensure efficient departmental operations.
• Performs charge audits by comparing itemized bills to medical record documentation to ensure appropriate charging.
• Review, assess, study, and analyze the overall coding, billing, documentation, and reimbursement system for potential compliance problems.
• Performs all other duties as assigned.

Qualifications & Experience:

Ability to consistently code at 95% accuracy and quality while maintaining client-specified production standards

Must successfully pass a coding test

Knowledge of medical terminology, ICD-9-CM and CPT-4 codes

Must be detail-oriented and can work independently

Computer knowledge of MS Office

Must display excellent interpersonal skills

The coder should demonstrate initiative and discipline in time management and assignment completion

The coder must be able to work in a virtual setting under minimal supervision

Intermediate knowledge of disease pathophysiology and drug utilization

Intermediate knowledge of MS-DRG classification and reimbursement structures

Intermediate knowledge of APC, OCE, NCCI classification and reimbursement structures

EDUCATION / EXPERIENCE

Associate degree in a relevant field preferred or a combination of the equivalent of education and experience

Three years of coding experience including hospital and consulting background

CERTIFICATES, LICENSES, REGISTRATIONS

AHIMA Credentials, and or AAPC

Certified Professional Medical Auditor by AAPC

PHYSICAL DEMANDS

Requires visual acuity to inspect and analyze work close to the eyes and ability to hear sound with or without correction; Ability to climb, stoop, kneel, reach, stand, walk pull, push lift, and able to exert up to 40 pounds of force occasionally and/or up to 10 pounds of force constantly to move objects.

Moderate physical activity performing somewhat strenuous daily activities of a primarily administrative nature.

The physical demands for this position include adequate vision, hearing, and repetitive motion.

Ascending or descending stairs, ramps, and the like, using feet and legs and/or hands and arms.

Substantial movements (motion) of the wrist, hands, and/or fingers in a repetitive manner - Bending legs downward and forward by bending leg and spine - Standing, particularly for sustained periods of time.

Using upper extremities to exert force to draw, drag, haul or tug objects in a sustained motion.

Raising objects from a lower to a higher position or moving object horizontally from position to position

WORK CONDITIONS

While performing the duties of this job, the employee is frequently required to stand, walk, sit, reach with hands and arms, and talk or hear.

The employee is occasionally required to stoop, kneel, crouch, or crawl and taste or smell.

The employee is required to have close visual acuity to perform an activity such as: preparing and analyzing data and figures, transcribing, and viewing a computer terminal.