Inpatient Coding Auditor

About the role

The Inpatient Coding Auditor will be responsible for the auditing of inpatient coders and auditing of offshore inpatient coding auditors to ensure coding accuracy standards are met. This role requires frequent and effective communication via phone, email, and instant messaging with various client teams and payers.

Responsibilities

• Knows, understands, incorporates, and demonstrates Huron’s Vision, and Values in behaviors, practices, and decisions.
• Responsible for the auditing of inpatient coders and/or inpatient “audit the auditors” to ensure coding accuracy and DRG accuracy of a minimum of 95% is met.
• Perform quality checks/audits on visits coded as per client SOPs.
• Perform calibration audits.
• Suggest improvements and schedule calibration sessions with offshore team counterparts and leaders.
• May assist in preparing audit reports, share direct feedback to coders and auditors on areas of opportunity, participate in client interactions and internal stakeholder meetings.
• Firm understanding of the clinical documentation guidelines.
• Maintain compliance with coding guidelines and ensure errors are identified during audits are corrected as appropriate, and corrective action is initiated before the claim is rebilled to the insurance.
• Conduct analysis and present summary of findings to leadership in a clear, concise, convincing, and actionable format.
• Utilizes encoder software applications, which includes all applicable online tools and references in the assignment of International Classification of Diseases, Clinical Modification (ICD-CM) diagnosis and procedure codes (ICD-PCS), MS-DRG, APR DRG, POA, SOI & ROM assignments.
• Ensures capture/reporting of appropriate code(s) by utilizing coding guidelines established by:The Centers for Disease Control (CDC), ICD-CM Official Coding Guidelines for Coding and Reporting, Centers for Medicare/Medicaid Services (CMS) ICD-PCS Official Guidelines for Coding and ReportingAmerican Hospital Association (AHA) Coding Clinic for International Classification of Diseases, Clinical ModificationAmerican Health Information Management Association (AHIMA) Standards of Ethical Coding
• Client coding procedures and guidelines
• Navigates the patient health record and other computer systems/sources to accurately determine diagnosis and procedures codes, MS-DRGs, APR DRGs, and identify HACs and PSIs or other indicators that could impact quality data and hospital reimbursement.
• Reviews inpatient health record documentation to assess the presence of clinical evidence/indicators to support diagnosis codes and MS-DRG, APR DRGs assignments to potentially decrease denials.
• Maintains a high degree of professional and ethical standards.
• Focuses on updating coding skills, knowledge, and accuracy by participating in coding team meetings and educational conferences.
• Maintains CEUs as appropriate for coding credentials as required by credentialing associations.
• Maintains current knowledge of changes in inpatient reimbursement guidelines and regulations as well as new applications or settings for inpatient coding e.g., Hospital at Home.
• Ensures patient information is correct and appropriate signatures are on all medical records.
• Demonstrates knowledge of current, compliant coder query practices when consulting with physicians, Clinical Documentation Specialists (CDS) or other healthcare providers when additional information is needed for coding and/or to clarify conflicting or ambiguous documentation.
• Performs other duties as assigned.

Qualifications

• Current permanent United States Work Authorization required
• Working in the United States Day shift schedule required
• 2+ years previous experience as an inpatient coding auditor
• 3+ years previous experience in coding inpatient hospital accounts
• Advanced proficiency with Microsoft office suite (Excel, Word, PowerPoint, Outlook, Visio, SharePoint)
• Analytical skills (problem solving, quantitative, workflow process, etc.)
• Ability to pay close attention to details; strong follow-up and follow-through skills
• Excellent time management skills; organized; ability to prioritize completing multiple tasks on schedule in a deadline driven environment
• Requires the use of independent judgement, discretion and decision-making abilities
• Ability to interact with internal and external customers in a professional manner
• Ability to ramp up on a client’s environment, processes, historical context, and systems to provide support to an engagement as soon as possible
• Financial acumen and analytical skills are required
• Experience working with data from various sources preferred
• Familiarity with revenue cycle systems, deep understanding of revenue cycle process flow and financial analysis
• Desire to work as part of a team in a partnership role
• Strong oral and written communication skills, analytical skills, ability to work independently, and be self-motivated are required
• Flexible and adaptable to changes

Physical Demands

• This role requires remaining seated at a desk/computer for 8 hours daily; repetitive use of computer keyboard and mouse; use of computer monitors for 8 hours daily; interaction though video/audio conference calls and possible use of a headset with microphone; very rarely duties might require the ability to lift up to 20 pounds and bending & standing for periods at a time.

Technical Qualifications

• Required Certifications: Certified Coding Specialist (CCS) or Certified Inpatient Coder (CIC) or Certified Documentation Improvement Practitioner (CDIP)
• Preferred Certifications: AHIMA microcredentials: “Auditing: Inpatient Coding (AIC)” Regishttp://expense.huronconsultinggroup.com/tered
• Health Information Administrator (RHIA) preferred
• Encoder experience (3M/Solventum, Encoder Pro, Codify) preferred
• Epic experience preferred
• Cerner experience preferred
• Meditech experience preferred

Key Performance Indicators (KPIs)

• Coding Auditing Productivity: ≥ 95% DRG Accuracy Rate
• Coding Accuracy: ≥ 95%
• Query Compliance: 100% adherence to AHIMA/ACDIS standards