Inpatient Coding Auditor

Inpatient Coding Auditor

Huron helps its clients drive growth, enhance performance and sustain leadership in the markets they serve. We help healthcare organizations build innovation capabilities and accelerate key growth initiatives, enabling organizations to own the future, instead of being disrupted by it. Together, we empower clients to create sustainable growth, optimize internal processes and deliver better consumer outcomes. Health systems, hospitals and medical clinics are under immense pressure to improve clinical outcomes and reduce the cost of providing patient care.

Investing in new partnerships, clinical services and technology is not enough to create meaningful and substantive change. To succeed long-term, healthcare organizations must empower leaders, clinicians, employees, affiliates and communities to build cultures that foster innovation to achieve the best outcomes for patients. Joining the Huron team means you'll help our clients evolve and adapt to the rapidly changing healthcare environment and optimize existing business operations, improve clinical outcomes, create a more consumer-centric healthcare experience, and drive physician, patient and employee engagement across the enterprise.

Join our team as the expert you are now and create your future.

The Inpatient Coding Auditor will be responsible for the auditing of inpatient coders and auditing of offshore inpatient coding auditors to ensure coding accuracy standards are met. This role requires frequent and effective communication via phone, email, and instant messaging with various client teams and payers. The Inpatient Coding Auditor will report to the Huron Managed Services Domestic Coding team.

• Knows, understands, incorporates, and demonstrates Huron's Vision, and Values in behaviors, practices, and decisions.
• Responsible for the auditing of inpatient coders and/or inpatient "audit the auditors" to ensure coding accuracy and DRG accuracy of a minimum of 95% is met.
• Perform quality checks/audits on visits coded as per client SOPs.
• Perform calibration audits.
• Suggest improvements and schedule calibration sessions with offshore team counterparts and leaders.
• May assist in preparing audit reports, share direct feedback to coders and auditors on areas of opportunity, participate in client interactions and internal stakeholder meetings.
• Firm understanding of the clinical documentation guidelines.
• Monitor compliance of coding guidelines and ensure errors are identified during audits are corrected as appropriate, and corrective action is initiated before the claim is rebilled to the insurance.
• Conduct analysis and present summary of findings to leadership in a clear, concise, convincing, and actionable format.
• Utilizes encoder software applications, which includes all applicable online tools and references in the assignment of International Classification of Diseases, Clinical Modification (ICD-CM) diagnosis and procedure codes (ICD-PCS), MS-DRG, APR DRG, POA, SOI & ROM assignments.
• Ensures capture/reporting of appropriate code(s) by utilizing coding guidelines established by:
• The Centers for Disease Control (CDC), ICD-CM Official Coding Guidelines for Coding and Reporting, Centers for Medicare/Medicaid Services (CMS) ICD-PCS Official Guidelines for Coding and Reporting
• American Hospital Association (AHA) Coding Clinic for International Classification of Diseases, Clinical Modification
• American Health Information Management Association (AHIMA) Standards of Ethical Coding
• Client coding procedures and guidelines
• Navigates the patient health record and other computer systems/sources to accurately determine diagnosis and procedures codes, MS-DRGs, APR DRGs, and identify HACs and PSIs or other indicators that could impact quality data and hospital reimbursement.
• Reviews inpatient health record documentation to assess the presence of clinical evidence/indicators to support diagnosis codes and MS-DRG, APR DRG assignments to potentially decrease denials.
• Maintains a high degree of professional and ethical standards.
• Focuses on updating coding skills, knowledge, and accuracy by participating in coding team meetings and educational conferences.
• Maintains CEUs as appropriate for coding credentials as required by credentialing associations.
• Maintains current knowledge of changes in inpatient reimbursement guidelines and regulations as well as new applications or settings for inpatient coding e.g., Hospital at Home.
• Ensure patient information is correct and appropriate signatures are on all medical records.
• Demonstrates knowledge of current, compliant coder query practices when consulting with physicians, Clinical Documentation Specialists (CDS) or other healthcare providers when additional information is needed for coding and/or to clarify conflicting or ambiguous documentation.
• Maintains a working knowledge of applicable coding and reimbursement Federal, State and local laws and regulations, Code of Ethics, as well as other policies and procedures to…