Position Summary: The Coding Auditor with training and communication with facilities and coding as needed.
Essential Duties and Responsibilities include the following: Other duties may be assigned.
- Work with offshore and stateside coding team and analyze coding reports ques to ensure coding is being completed on time and in a quality manner.
- Review and analyze client reports related to coding and denials. Work with Revenue Cycle team on rejections and denials. Review reports to identify specific issues, investigate and correct as per the coding guidelines, and implement solutions.
- Perform super audit results to ensure top quality.
- Perform Coding audits for Hospital Same Day Surgery, Ambulatory Surgery and/or Hospital Inpatient DRG accounts.
- Assist Manager with coding questions relating to client services and coding/audit operations.
- Be available to staff to answer any questions they have regarding coding
- Assist with creating coder monthly education power point and training.
- Assist with creating and updating coding SOP and Client/Facility guidelines.
- Assist with coding in urgent situations where a coder is unavailable, or client need is immediate
- Provide education to providers regarding areas of documentation improvement that affect coding,
Auditing requirements:
- Ability to communicate why a code is incorrect, what the correct code should be, and why new code is to be used
- Assist in finding conditions or complications that would change the code assignment
- Understanding of payor rules (commercial and government) that affect coding assignment
- Understanding of medical necessity guidelines and documentation requirements to meet these guidelines
- Knowledge of when to query a physician for clarification or record amendment as needed for proper code assignment
- Resources allowed for coding – authoritative vs. opinionated resources
Qualifications: To perform the job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Education/Experience:
- High School Diploma or equivalency
- Effective English communication skills, both written and verbal
- Expert level experience with Microsoft Office Products- ability to create and build spreadsheets and reports in Excel
- 3-5 years Coding experience in Hospital Same Day Surgery, Ambulatory Surgery and Hospital Inpatient DRG coding.
- Coding Certification (one or more of the following: CPC, CCS, COC, RHIA, RHIT, CIC)
- Maintain current knowledge and adhere to appropriate regulatory standards such as Government