Inpatient Coding Compliance Auditor (Remote)

Summary:
The Inpatient Coding Compliance Auditor audits hospital inpatient claims to ensure compliant coding and identify potential risks and opportunities for improvement as part of the Corporate Compliance Department's routine auditing and monitoring program.
Essential Duties and Responsibilities:

• Conducts audits by reviewing medical records and claims for accuracy of ICD-10-CM and ICD-10-PCS codes, DRG and APR-DRG assignments, POA indicators, Severity of Illness and Risk of Mortality assignment, and other billed data elements. Evaluates documentation for query opportunity and clinical validity. Follows established procedures in documenting and communicating audit findings.
• Designs, prepares, distributes/routes, and archives audit documentation using spreadsheet software and/or audit software, following established procedures for audit workflow, documentation and retention.
• Conducts research and locates reference material needed for performance of audits. Keeps abreast of regulatory changes and participates in continuing education. Consults with subject matter experts as necessary, including Clinical Documentation Improvement and Quality leadership. Maintains proficiency in Official Guidelines for Coding and Reporting, AHA Coding Clinics, AHIMA/ACDIS Query Practice Brief, and other relevant coding guidance documents as well as clinical topics to include pathophysiology, pharmacology, and medical technology.
• Ensures that claims corrections and re-billing occurs as necessary to remedy any identified over/underpayments or data quality issues.
• Provides education and feedback to coders and other relevant stakeholders regarding audit findings. Contributes to the development of educational material such as newsletters, webinars, and/or ALC content.
• Participates in departmental and team meetings to foster collaboration and accomplish organizational, departmental, and team goals.
• Abides by Employee Handbook, Corporate Code of Conduct, organizational, departmental and team policies and procedures. Maintains productivity levels and accountability for completion of audit assignments and milestones as set forth by Corporate Compliance Directors, Senior Directors and VP.
• Performs other duties as assigned by Corporate Compliance Directors, Senior Directors, and VP.

Qualifications:

• Required Education: AS/AA Degree or Certificate Program Equivalent.
  Requires extensive knowledge of CPT, HCPCS, ICD 10 CM/PCS coding, and medical terminology.
• Preferred Education: BS/BA degree or higher
• Required Experience: Minimum of 3 years of hospital Inpatient Coding and abstracting experience in ICD-10-CM, ICD-10-PCS, DRG and APR-DRG assignment.
• Preferred Experience: Hospital Inpatient Coding and/or clinical documentation auditing experience.
• Required License/Registration/Certification: AHIMA credential (CCS, RHIA, or RHIT).
• Preferred License/Registration/Certification: Combination of AHIMA credentials (CCS, RHIA, RHIT, CCDS) and other related credentials (LPN, RN, CHC or similar).
• Computer Skills Required: Proficient in Microsoft Office and/or Google Suite applications, Encoder software, and electronic medical record systems (Cerner, McKesson, MedHost, EPIC, or similar).

Physical Demands:
In order to successfully perform this job, with or without a reasonable accommodation, the following are outlined below:

• The Employee is required to read, review, prepare and analyze written data and figures, using a PC or similar, and should possess visual acuity.
• The Employee may be required to occasionally climb, push, stand, walk, reach, grasp, kneel, stoop, and/or perform repetitive motions.
• The Employee is not substantially exposed to adverse environmental conditions and; therefore, job functions are typically performed under conditions such as those found within general office or administrative work.