Coding Quality Auditor

About the role

The Coding Quality Auditor position ensures accuracy in code assignment of diagnosis and procedure to outpatient and/or inpatient encounters based upon documentation within the electronic medical record while maintaining compliance with established rules and regulatory body guidelines.

Responsibilities

• Data quality review to ensure data integrity, coding accuracy, and revenue preservation
• Participate in quality review and performance improvement projects throughout the department or facility
• Responds promptly to internal and external customer coding/DRG requests
• Provides assistance to the leadership team or other coders with coding of the accounts or answering questions from other coders relating to coding and work flows
• Initiates queries with physicians to obtain or clarify diagnoses and/or procedures as appropriate, utilizing the established physician query process
• Assists with quality assurance (peer) reviews to ensure data integrity and accuracy of coding, identifies opportunities for improvements, and makes recommendations for optimal enhancements
• Assists Case Management and Patient Access Departments in providing appropriate CPT codes for pre-admission and pre-certification requirements including the inpatient only process
• Affords assistance to Clinical Documentation Management Program (CDMP) with appropriate MS-DRG and APR-DRG assignment, sequencing of diagnoses and procedures, and coding and documentation training
• Affords assistance in the development of documentation protocols for physicians
• Represents the coding area in Hospital meeting/events when necessary (e.g., Performance Improvement Committees)
• Maintains and achieves the highest standards of coding quality by assigning accurate ICD-9-CM/ICD-10-CM/ICD-10-PCS and CPT codes utilizing an electronic encoder application in accordance with hospital policy and regulatory body guidelines
• Performs accurate, optimal DRG and APC assignment, in accordance with nationally established rules and guidelines based upon documentation within the medical record
• Reviews discharge disposition entered by nursing and corrects if necessary in order to achieve the highest quality of entered data
• Assigns and enters physician identification number and procedure date correctly in the medical record abstracting system
• Reviews medical record documentation and abstracts data into the encoder and Electronic Health Record (EHR) abstracting system to determine principal or final diagnosis, co-morbid conditions and complications, secondary conditions and procedures
• Affords assistance with quality reviews of outpatient or inpatient accounts and/or training of new coders
• Complies with the Standards of Ethical Coding as set forth by the American Health Information Management Association (AHIMA) and adheres to official guidelines
• Affords aggregation of data from reviews and compiles reports for HIM management
• Utilizes time effectively. Consistently codes and abstracts at departmental standards of productivity while ensuring accuracy of coding
• Affords assistance in making sure coding bill hold goal is met
• Maintains coding timeframes within acceptable guidelines by ensuring all work items assigned to the coding queues and worklists are processed in a timely manner
• Critically evaluates her or his own performance, accepts constructive criticism, and looks for ways to improve
• Contributes ideas to help improve quality of coding data and abstracting data

Qualifications

• Education: Associate’s degree or higher in a Commission on Accreditation in Health Informatics and Information Management accredited program required or additional two years of experience (in addition to the minimum experience requirements listed below) required in lieu of degree
• Licenses and Certifications: Required to have one of the following: RHIT, RHIA, or CCS from AHIMA

Skills and Abilities

• Demonstrates the skills and competencies necessary to safely perform the assigned job, determined through ongoing skills, competency assessments, and performance evaluations
• Sufficient proficiency in speaking, reading, and writing the English language necessary to perform the essential functions of this job, especially with regard to activities impacting patient or employee safety or security
• Knowledge of an electronic medical record and imaging systems
• Working knowledge of medical terminology, anatomy and physiology
• Proficiency with electronic encoder application
• AHIMA designated ICD-10 Approved Trainer preferred

Benefits

Not specified

Pay

Not specified

Schedule

Not specified