HIM Coding Quality Auditor

Overview

This position is responsible for ongoing quality review and assessment of coded hospital data. Performs audits on the accuracy of ICD-10, CPT-4, MS-DRG, APR-DRG and APC assignments. Performs review of claims denied for coding, documentation, and clinical validation, and formulates and submits letters of appeal. Prepares reports for management review and identifies trends. Conducts focused retrospective audits and regular scheduled audits of individual coders.

Manages all audits conducted by internal and external entities and responds to requests for code verification. In conjunction with the Coding Supervisors and Coding Manager, contributes to the development of educational and training opportunities for staff.

Minimum Education and Experience Requirements

• One of the following credentials is required:
  Registered Health Information Administrator (RHIA), Certified Coding Specialist (CCS), Registered Health Information Technician (RHIT), Certified Professional Coder (CPC), Certified Professional Coder–Hospital (CPC-H), or Registered Nurse (RN) with education and experiential training in Medical Coding, Utilization Review, Denial Management, Case Management, or related functions.
• AHIMA Certified ICD-10-CM/PCS Trainer designation preferred.
• Minimum of five (5) years of experience in hospital inpatient and/or outpatient medical record review, coding, and reimbursement required.
• Coding audit experience preferred.
• Strong knowledge of ICD-9-CM, ICD-10-CM/PCS, CPT coding, and prospective payment systems required.
• Proficiency with Microsoft Windows operating systems and Microsoft Office applications, including Word, Excel, and PowerPoint, as well as coding/grouping software.
• Demonstrated ability to work with minimal supervision and function independently as a self‑starter.
• Ability to communicate clearly and effectively, both verbally and in writing.
• Ability to generate reports for management review that present audit results in a clear and concise manner.
• Ability to meet deadlines and adapt to frequent regulatory changes.
• Ability to maintain positive and productive relationships with internal and external teams and customers.

Employees in this position will operate vehicles for an assigned business purpose as a non-frequent driver
.