Coding Services Auditor

About the role

The Coding Services Auditor is responsible for conducting prebill and retrospective reviews to include not limited to: focused reviews on identified opportunities, mortality, PSI (patient safety indicators) and coder focused audits. Reviews to include full DRG validation, review of assigned ICD-10-CM/PCS, POA indicators codes, validation of all abstracting elements, review for query opportunities affecting DRG, severity of illness, and/or risk of mortality scores. Auditor will use Vizient to identify potential opportunities during chart reviews. All audits performed will be to ensure compliance with current coding guidelines and regulatory standards. The Auditor will use critical thinking skills and their knowledge of coding/compliance guidelines to identify potential documentation, coding and reimbursement issues and report these to the leadership. The Coding Services Auditor will actively participate in team meetings serving as a subject matter expert discussing any trends identified during their reviews and make suggestions for continual process improvement. Coding Services Auditor should be able to set priorities and manage one's own assignments to ensure organizational goals are met and demonstrate the ability to follow processes related to scope of work. The Coding Services Auditor should be able to document detailed data into audit software with a high level of accuracy.

Core responsibilities

• Perform Prebill and Retrospective Reviews:
  • Validate assigned ICD-10-CM/PCS codes, abstracting data elements and DRGs are correct/appropriate according to official coding guidelines and supported by clinical documentation in the medical record. Performs audits at a minimum accuracy and productivity rate upon completion of audit.
  • Validate abstracting data to include but not limited to: POA, Point of Origin, Admission source, discharge disposition are correct.
  • Validate adherence to WellStar Coding Policies and Procedures.
  • Validate adherence to Wellstar Coding Query Policy.
  • Reviews and identifies coding opportunities on mortality accounts using validation criteria from Vizient as well as other sources.
  • Identifies query opportunities or other documentation improvements on reviews.
• Data Capture and Reporting:
  • Collects and appropriately records data in auditing software and/or spreadsheets to include but not limited to: Cloudmed, EPIC, Institutional Audit Manager and other spreadsheets at accuracy.
  • Follows verbal and written processes and instructions.
  • Works responsibilities/assignments in accordance given to by leadership and communicates any outstanding negative impacts on CFB within role or work left undone daily.
  • Communicates messages verbally and via email in a manner to achieve an objective.
  • Performs other duties in support of team in regards to data and reporting.
• Education and Participation:
  • Assists with onboarding new staff.
  • Provides feedback to coding staff and leadership on areas of opportunity verbally as well as via software.
  • Provides feedback to CDI on coding knowledge via verbally and software systems.
  • Provide feedback to coding leadership on documentation improvement opportunities.
  • Serves as a subject matter expert for 2nd opinions requests other requests from internal/external customers.
  • Participants and represents owning area in team and other meetings.
  • Participates in creation and roll out of action and process improvement plans to address coding issues found through review and data trending.
  • Review and stay abreast of the latest CMS and state guidelines, official coding guidelines, official coding advice (coding clinic) and all coding updates. Communicate knowledge of these and engages in conversations of potential impacts.
  • Performs other duties as assigned to include but not limited to preparation of educational material, instructions, and tip sheets.
• Codes/abstracts/audits accounts:
  • Accurately and completely assigns appropriate ICD-10 CM/PCS and/or CPT/HCPCS codes to the greatest specificity with a minimum accuracy rate in accordance with Coding and WHS guidelines.
  • Accurately and completely abstracts all required data into the appropriate data fields in compliance with statistical data requirements with a minimum of accuracy rate.
  • Meet productivity standards.
  • Queries physicians to further clarify code assignments, if needed.
• Performs other duties as assigned.
• Complies with all Wellstar Health System policies, standards of work, and code of conduct.

Qualifications

Education: High School Diploma General required. Associates Health Information Management preferred. Associates Other preferred.

Required License(s) and Certification(s): All certifications are required upon hire unless otherwise stated.

• CCS - Cert Coding Spec (Upon Hire preferred)
• RHIA - Reg Health Information Admin (Upon Hire preferred)
• RHIT - Reg Health Information Tech (Upon Hire preferred)
• CPC - Cert Prof Coder (Upon Hire preferred)

Experience: Minimum 3 years of hospital-based inpatient services coding experience currently meeting accuracy in abstracting, coding and DRG assignment while meeting productivity requirements or passing score on the coding assessment provided by Coding department, if applicable. Previous auditing in an acute care setting or lead experience highly preferred.

Required skills

• Articulate with critical thinking skills.
• Extensive knowledge of medical terminology, disease processes, pharmacology, anatomy and physiology.
• Competent or an ability to learn software systems to include Microsoft, 3M360, Epic EMR, auditing software.