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
• Assists 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
• Assists 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
• Aggrees data from reviews and compiles reports for HIM management

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
• Experience: Five years of coding experience relevant to the area auditing (e.g., inpatient, outpatient, professional fee)
• Licenses and Certifications: Required Muat 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

Supplemental Requirements

• Work Attire: Uniform: No Scrubs: No Business professional: Yes Other (department approved): No
• On Call*: No
• Travel**: May require travel within the Houston Metropolitan area Yes May require travel outside Houston Metropolitan area Yes

Company Information

Houston Methodist is an Equal Opportunity Employer.