Coding Auditor-Compliance- Inpatient Auditing - Day

Schedule & Location:

Full-Time: 80 hours, biweekly

Monday-Friday: 8am-4:30pm

Remote work opportunity 

Job Description:

Under the general supervision of the Manager – Compliance Risk and Facility Audits, assists in planning the scope, objectives, and approach of audit projects. Completes medical record reviews in pre-identified areas to assess compliance with applicable laws and regulations in key areas of medical necessity, coding sequencing and clinical documentation of billed charges. Prepares and presents written and oral reports summarizing audit work, issues identified and recommendations to management. Assists with the identification and execution of solutions to correct any issues identified. Maintains audit records in compliance with System policy. Educates members of the patient care team on documentation guidelines/solutions identified through the audit activity as directed

Duties and Responsibilities:

1. Assesses medical record documentation for coding compliance and compliance with applicable laws and regulations in areas such as medical necessity, coding sequencing and clinical documentation in support of billed charges.
2. Demonstrates knowledge of DRGs, documentation requirements, current coding guidelines and the chart review process.
3. Documents audit results in the appropriate system as directed.
4. Prepares written reports pertaining to determinations and recommendations resulting from routine audits and/or assigned special projects. Presents reports to appropriate managers and boards as needed.
5. Educates internal customers on compliant documentation opportunities and coding and reimbursement issues.
6. Assists with planning, developing, and recommending objectives, procedures, and systems to be used in auditing entities, functions, and departments throughout the System.
7. Investigates and recommends action to be taken when control, operational weaknesses and/or compliance issues are found. Monitors implementation of recommended corrective action and performs follow up reviews where necessary.
8. Assists with compliance program implementation throughout the organization.
9. Assists with monitoring the Compliance Program.
10. Assists in the development and dissemination of education and training processes for the employees regarding compliance related activities.
11. Assists with any investigations in accordance with the investigation protocol established by the organization.
12. Assists in responding to questions, issues, concerns, and reports of possible misconduct reported or identified through the
13. organization's hotline or other reporting lines.
14. Assists with the development and oversight of the implementation of corrective action plans to address noncompliance.
15. Supports the organization's commitment to comply with all federal, state, and local standards, with an emphasis on
16. prevention of fraud and abuse.
17. Promotes and adheres to the Code of Conduct and the elements of the Compliance Program and exercises due diligence to ensure compliance with policies and legal requirements.

Qualifications:

• Minimum Experience:
  • 5 years’ experience in ICD-10 coding with a strong understanding of Medicare’s Inpatient DRG and other PPS methodologies; CPT coding knowledge
  • Must have inpatient coding experience

• Min Field of Expertise: Health Information Management

• Minimum Education:
  • Bachelor's Degree

• Required Certification:
  • Certified Coding Specialist (CCS) or equivalent (or obtain within a year)

• Skills:
  • A working knowledge of chart review processes and knowledgeable of current Coding Clinic guidance; Knowledge of Federal Regulatory resources; Clinical knowledge and understanding of disease processes and/or ability to research this topic; Ability to interact effectively and professionally with physicians, other health care professionals, managers, executives, and various support staff departments in a poised, non-confrontational manner; Strong organizational skill and detail oriented; Excellent written and verbal communication skills including ability to develop and deliver formal presentations; Proficient with computer systems and in use of MS Office software products; self-motivated with the ability to work under minimum supervision while understanding the importance of being a part of a team.

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