Hospital Coding Quality Specialist - REMOTE

Hospital Coding Quality Specialist - REMOTE

Apply for the Hospital Coding Quality Specialist - REMOTE role at Aurora Health Care. Aurora Health Care provides a competitive pay range. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.

$28.05/hr - $42.10/hr

• Complete hospital coding accuracy reviews to assist coding leadership in carrying out the department’s compliance plan and ensuring accurate coding of documentation and appropriate reimbursement.
• Review coded health information records to evaluate the quality of staff coding and abstracting, verify accuracy of diagnostic and procedure codes, and other abstracted data such as discharge disposition; ensure accurate coding for outpatient, day surgery and inpatient records; verify all codes and sequencing for claims according to AHA coding guidelines, CPT Assistant, AHA Coding Clinic and national/local coverage decisions.
• Work collaboratively with coding leadership to review records with focused diagnosis and procedure codes, including specific APCs, DRGs and OIG work‑plan targets, to assure compliance in all areas of coding.
• Identify focused prospective records that need to be reviewed.
• Identify coder education opportunities, team trends, and consideration of topics to mandate for second‑level account review before the account is final coded.
• Review encounters flagged for second‑level review, such as hospital‑acquired conditions, complications and other identified core measures or trends; perform risk‑adjustment reviews for accurate severity and risk‑of‑mortality assignment.
• Participate in the Clinical Documentation Improvement and Hospital Coding alignment process; review accounts with mismatched DRG assignment following notification from the inpatient coder; determine the appropriate DRG; follow up with the clinical documentation nurse; recommend educational topics based on mismatches.
• Participate in hospital coding denial and appeal processes; ensure timely review and response to third‑party payer notifications; determine if an appeal will be written based on coding guidelines and provider documentation.
• After review of over payment or underpayment denials, provide follow‑up to the coding team, re‑bill accounts as needed, and present trends to coding leadership in a timely manner.
• Investigate and resolve all edits or inquiries from the billing office or patient accounts to prevent claim‑submission delays; clarify changes in coding guidance or educational materials.
• Maintain continuing education credits and credentials, stay abreast of current knowledge trends, legislative issues, and technology in Health Information Management, and identify opportunities for the coding team.

• Monday through Friday:
  First Shift
• This is a REMOTE opportunity.

• Coding Specialist (CCS) certification issued by the American Health Information Management Association (AHIMA)
• Health Information Administrator (RHIA) registration issued by the American Health Information Management Association (AHIMA)
• Health Information Technician (RHIT) registration issued by the American Health Information Management Association (AHIMA)

• Associate’s Degree in Health Information Management or related field.

Typically requires 5 years of experience in hospital coding for a large complex health care system, which includes hospital coding, denial review and/or coding quality review functions.

• Demonstrated leadership skills and abilities.
• Knowledge of National Council on Compensation Insurance (NCCI) edits and local/national coverage decisions.
• Expert knowledge of ICD‑10‑CM/PCS, CPT, G‑codes, HCPCS, modifiers, APC, MS‑DRGs.
• Advanced Microsoft Applications (Excel, Word, PowerPoint, Teams) proficiency.
• Advanced knowledge of anatomy, physiology, medical terminology, pathophysiology, surgical terminology and pharmacology.
• Advanced pharmacology knowledge of drug indications and adverse reactions.
• Expertise in coding workflow and technology optimization, including navigation of electronic health records and billing systems.
• Excellent communication and reading comprehension skills.
• Analytical aptitude with high attention to detail and accuracy.
• Initiative and ability to collaborate with others.
• Experience with remote workforce operations.
• Strong sense of ethics.

Not Applicable

Full‑time

Other