Hospital Coding Auditor

Responsibilities

• Reviews patient records for correct ICD-10-CM/PCS codes, CPT Codes, POA assignment and MS-DRG assignment according to established guidelines and scores appropriately, if applicable.
• Works with CDIS on DRG assignment and educates on missed Query opportunities.
• Works with staff on coding guidelines and correct code assignment.
• Informs manager of any activities which do not meet federal or state coding and billing requirements.
• Appeals RAC DRG review charts.
• Receives requests from business office on issues relating to coding and responds within 5 working days, if possible.
• Reviews discharge summaries for coding accuracy.
• Affords assistance in identifying potential identity errors.
• Coding Clinics are reviewed and applied appropriately.
• Affords assistance in other duties as assigned to support the operational needs of the department and organization.

Qualifications

• Minimum Education: Technical Diploma/Certificate Coding Required
• Minimum Work Experience: 5 years Inpatient and/or outpatient coding experience Required
• Experience: Regulatory issues related to Medicare, and other third-party payers as it relates to hospital and ambulatory coding and billing. Required
• Licenses and Certifications: Certified Coding Specialist (CCS_AHIMA) Required or Certified Professional Coder (CPC_AAPC) Required or Certified Coding Associate (CCA_AHIMA) Required