Position: Coding Auditor (ICD-10)
Duration: Full-Time
Location: Newark/Wall NJ
Job Summary:
This position is responsible for conducting on site audits of hospital billing and coding practices and desk audits; forms development, profiling and tracking institutional audit trends. Performs and finalizes multiple per diem, bill verification, DRG Validation (utilization review audits) and credit balance. Additionally provides guidance/instruction to various stakeholders on ICD9-CM, ICD-10, DRG assignment payment and auditing.
Responsibilities:
• Identifies and presents billing discrepancies found during audit and coordinates referral of improper claim payments through the appropriate channels.
• Identifies error trends as they relate to medical record and or billing documentation or misinterpretation of provider contract stipulations.
• Compiles statistics and other audit information to present to accounts, regulatory agencies, and internal requesters.
• Reviews and updates audit processes with manager for purposes of keeping up with new innovations in clinical data review and company cost containment initiatives.
• Required to train new staff on department/audit procedures.
• Performs other special assignments as requested by manager.
• Demonstrates knowledge, understanding and conforms to laws, regulations and policies that pertain to the organizational units business.
Knowledge:
• Requires knowledge of medical terminology, detailed knowledge of anatomy & physiology, disease pathogenesis and treatment including procedural drug therapies, ancillary and diagnostic services.
• Requires knowledge of principles of utilization management.
• Requires knowledge of hospital structures and payment systems.
• Requires knowledge of Centers of Medicare and Medicaid prospective payment system regulations.
• Prefers knowledge of ACCESS Software.
• Must have effective verbal and written communication skills and demonstrate the ability to work well within a team. Demonstrated ability to deliver highly technical information to less technical individuals.
• Must have strong PC skills experience with MICROSOFT office programs: excel, word and power point.
• Must demonstrate professional and ethical business practices, adherence to company standards, and a commitment to personal and professional development.
• Proven time management skills are necessary. Must demonstrate the ability to manage multiple priorities [or tasks], deliver timely and accurate work products with a customer service focus, and respond with a sense of urgency as required. Demonstrated ability to work in a production focused environment.
• Proven ability to ask probing questions and obtain thorough and relevant information.
• Needs to demonstrate willingness to cross-train, and be cross-trained, in other roles/duties.
• Must be detail oriented with strong organizational and data processing skills. Proven ability to follow detailed instructions is essential, along with proven problem solving skills.
• Proven analytical, research and problem solving skills a must.
Travel (If Applicable):
• Field position: 85 to 90% of time spent in the field at various facilities in NJ, PA & NY
Qualifications:
Education:
• Requires a Bachelor's degree in Health Information Management or related field; or a RN with CCS certification.
Experience:
• Requires a minimum of 3 years of experience in a medical records department of an acute care hospital or other health care facility. Experience with DRG validation, ICD-9-CM or ICD-10 training and education.
Additional licensing, certifications, registrations:
• Requires RHIA or RHIT certification; or RN with CCS certification.
• Valid Driver's license and access to a car.