Medical Coding Auditor

Job Summary:

Conducts data quality audits of inpatient admissions and outpatient encounters to validate coding assignment complies with the official coding guidelines as supported by clinical documentation in health records. Validates abstracted data elements that are integral to appropriate payment methodology. Responsible for effectively communicating information and audit findings through presentations, graphs, reports, and educational materials, etc.

Job Responsibilities/Duties:

· Chart Analysis IP, OP Coding Data auditing and validation:
Reviews medical records for the determination of accurate assignment of all documented diagnoses and procedures. Adheres to Standards of Ethical Coding (AHIMA). Reviews medical records for the determination of accurate assignment of all documented diagnoses and procedures. Reviews claim to validate abstracted data including but limited to discharge disposition which impacts facility reimbursement and/or MS-DRG assignment. Adheres to Standards of Ethical Coding (AHIMA).

Reviews medical records to determine accurate required abstracting elements (facility/client/payer-specific elements) including appropriate discharge disposition

· IP, OP Coding:
Reviews medical records for the determination of accurate assignment of all documented ICD-10-CM codes for diagnoses and procedures. Abstracts accurate required data elements (facility/client specific elements) including appropriate discharge disposition.

· Coding:
Uses discretion and specialized coding training and experience to accurately assign ICD-10, CPT-4 codes to patient medical records.

· Abstracting:
Reviews medical records to determine accurate required abstracting elements (client specific elements) including appropriate discharge disposition.

· Coding Quality:
Demonstrates ability to achieve accuracy and consistency in the selection of principal and secondary diagnoses (including MCC & CC) and procedures. Demonstrates ability to achieve accuracy and consistency in abstracting elements defined by SOW.

· Professional Development:
Stays current with AHA Official Coding and Reporting Guidelines, CMS and other agency directives for ICD-10-CM and CPT coding. Attends mandatory coding seminars on an annual basis (IPPS and OPPS, ICD-10-CM, and CPT updates) for inpatient and outpatient coding. Quarterly review of AHA Coding Clinic. Attends Quarterly Coding Updates and all coding conference calls

· Create audit schedules and manage workflows to adhere to the audit schedule.

· Develop methods to effectively communicate information through presentations, graphs, reports, educational materials, etc.

· Develop, establish, and review policies and objectives consistent with those of the organization to ensure efficient departmental operations.

· Performs charge audits by comparing itemized bills to medical record documentation to ensure appropriate charging.

· Review, assess, study, and analyze the overall coding, billing, documentation, and reimbursement system for potential compliance problems.

· Performs all other duties as assigned.

Qualifications &

Experience:

· Ability to consistently code at 95% accuracy and quality while maintaining client-specified production standards

· Must successfully pass a coding test

· Knowledge of medical terminology, ICD-9-CM and CPT-4 codes

· Must be detail-oriented and can work independently

· Computer knowledge of MS Office

· Must display excellent interpersonal skills

· The coder should demonstrate initiative and discipline in time management and assignment completion

· The coder must be able to work in a virtual setting under minimal supervision

· Intermediate knowledge of disease pathophysiology and drug utilization

· Intermediate knowledge of MS-DRG classification and reimbursement structures

· Intermediate knowledge of APC, OCE, NCCI classification and reimbursement structures

EDUCATION / EXPERIENCE

· Associate degree in a relevant field preferred or a combination of the equivalent of education and experience

· Three years of coding experience including hospital and consulting background

CERTIFICATES, LICENSES, REGISTRATIONS

· AHIMA Credentials, and or AAPC

· Certified Professional Medical Auditor by AAPC

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