Acute Coding Quality Review Auditor (Remote)

About the role

Located in the metropolitan area of Sacramento, the Adventist Health corporate headquarters have been based in Roseville, California, for more than 40 years. In 2019, we unveiled our WELL-certified campus - a rejuvenating place for associates systemwide to collaborate, innovate and connect. Adventist Health Roseville and shared service teams have access to enjoy a welcoming space designed to promote well-being and inspire your best work.

Responsibilities

• Performs quality reviews and audits to ensure compliance with DRG validation, ICD-10/PCS, and CPT coding guidelines.
• Codifies and audits hospital inpatient and/or outpatient coding, prepares detailed audit reports outlining findings, recommendations, rationale, and corrective actions needed.
• Facilitates the coder audit appeal process, providing rationale and education to the coding team as required.
• Assists team members with coding questions and provide resolution guidance.
• Ensures coding staff adherence with coding guidelines and policy, both internal and vendor teams.
• Communicates appropriately with manager and all stakeholders as required.
• Maintains working knowledge of workflows, systems, and tools used in the department.
• Reviews all official data quality standards, coding guidelines, company policies and procedures, and clinical/medical resources to assure coding knowledge and skills remain current.
• Assists in creation and maintenance of a positive working environment, including effective communication and setting an appropriate professional example.

Requirements

• Education and Work Experience: High School Education/GED or equivalent: Required Associate’s/Technical Degree or equivalent combination of education/related experience: Preferred Five years' acute care inpatient and/or outpatient coding experience: Required Three years' coding auditing/monitoring experience: Preferred
• Licenses/Certifications: Certified Coding Specialist credential through AHIMA: Required Certified Coding Specialist (CCS): Required

Qualifications

• Uses in depth understanding of the CQR quality workplan to will promote compliance and awareness of the plan.
• Acts as a subject matter expert (SME) in national coding guidelines for hospital inpatient and/or outpatient and will ensure compliance with those guidelines along with all company coding policies.
• Uses performance improvement analyses to improve the accuracy, integrity and quality of patient data, ensure minimal variation in coding practices, and improve the quality of physician documentation within the body of the medical record to support code assignments which results in appropriate reimbursement and data integrity.

Skills

• Proficiency in facilitation and interpersonal communication, organizational skills, prioritization of tasks, professionalism, and educating and training as required.
• Uses performance improvement analyses to improve the accuracy, integrity and quality of patient data, ensure minimal variation in coding practices, and improve the quality of physician documentation within the body of the medical record to support code assignments which results in appropriate reimbursement and data integrity.

Benefits

Adventist Health is committed to the safety and wellbeing of our associates and patients. Therefore, we require that all associates receive all required vaccinations as a condition of employment and annually thereafter, where applicable. Medical and religious exemptions may apply.

Pay

The estimated base pay for this position is $36.91 to $50.62. Additional individual compensation may be available for this role through differentials, extra shift incentives, bonuses, etc. Base pay is only a portion of the total rewards package, and a comprehensive benefits program is available for qualifying positions. Please contact our Talent Acquisition team for more information.

Schedule

Shift Length: 8 Hours

About Us

Adventist Health is a faith-based, nonprofit, integrated health system serving more than 100 communities on the West Coast and Hawaii with over 440 sites of care, including 27 acute care facilities. Founded on Adventist heritage and values, Adventist Health provides care in hospitals, clinics, home care, and hospice agencies in both rural and urban communities. Our compassionate and talented team of more than 38,000 includes employees, physicians, Medical Staff, and volunteers driven in pursuit of one mission: living God's love by inspiring health, wholeness and hope.