Hospital Coding Auditor
Seton Medical Center Harker Heights
- Brentwood, TN
- Permanent
- Full-time
Responsibilities
- Perform in-depth quality assurance audits of hospital (inpatient and outpatient) claims to support ICD-10-CM and ICD-10 PCS codes and MS-DRG and APR-DRG assignments and/or CPT-4 and APC assignments, based on clinical documentation
- Audit patient records, reviewing diagnosis and procedures for coding compliance with local, state, federal coding regulations and guidelines
- Identify occurrences of “over” or “under” coding of patient records
- Identify potential documentation issues
- Prepare detailed reports on audit findings
- Present audit findings, education, and trends to physicians, coders, and/or other facility professionals on a monthly, quarterly and/or yearly basis
- Serve as an expert in Outpatient Prospective Payment System and/or Inpatient Prospective Payment System.
- Create consistency and efficiency in outpatient or inpatient claims processing and data collection to optimize APC, ASC or DRG reimbursement.
- Assists management with training new Coders or Clinical DRG Auditors to include daily monitoring, mentoring, feedback and education.
- High school diploma.
- Associate's degree, preferred.
- Active RN license, preferred.
- One of the following coding certifications required: RHIA, RHIT, CCS, CIC, CCDS, CDIP or CPC.
- 3+ years of MS DRG/APR DRG coding or auditing experience with expert knowledge of ICD-10 Official Coding Guidelines and DRG reimbursement methodologies.
- Epic experience required.
- Clinical experience in an inpatient hospital setting, preferred.
- Expert knowledge of ICD -10-CM coding including but not limited to; expert knowledge of principal diagnosis selection, complications/comorbidities (CCs) and major complications/comorbidities (MCCs), and conditions that impact severity of illness (SOI) and risk of mortality (ROM)
- Expert knowledge of ICD-10-PCS coding methodologies, code sequencing, and discharge disposition in accordance with CMS requirements, Official Guidelines for Coding and Reporting, and Coding Clinic guidance
- Ability to apply clinical review judgment to make clinical determinations
- Proficiency in computer skills and typing, i.e., Microsoft Windows, Outlook, Excel, Word, PowerPoint, Internet browsers and in virtual meeting tools i.e., Microsoft Teams, Zoom, etc.