Remote Clinical Denials & Appeals Auditor

About the role

Performs inpatient coding DRG denial audits of RAC and non-RAC payer accounts, for the HIM Department at the Corporate office. Reviews patient records for accuracy in ICD-9-CM coding, ICD-10-CM/PCS, DRG assignment, present on admission indicators (POA), discharge disposition and any other pertinent data needed to capture coding accuracy. Provides audit feedback via the auditing process to pertinent parties, i.e. HIM Director, Corporate Coding Manager, etc. Assists in preparation of the monthly and quarterly denials audit reports. Applied knowledge of medical terminology, pathophysiology, and pharmacology. Demonstrates tested data quality and integrity skills. Franklin, close neighbor to the much larger Nashville, is a livable city with a lovely historic downtown. The city's Main Street bustles with thriving small businesses and eateries, offering visitors and residents no shortage of entertainment options. The Franklin Theatre, established in 1937, is a cultural icon, boasting an ever-impressive roster of regional and national touring musicians, and showing classic movies on a weekly basis. Two annual Main Street Festivals reinforce the vibrant identity of the city and Pumpkinfest is a resident favorite, welcoming in autumn in style. At AMN Healthcare, we strive to be recognized as the most trusted, innovative, and influential force in helping healthcare organizations provide quality patient care that continually evolves to make healthcare more human, more effective, and more achievable.

Responsibilities

• Performs inpatient coding denial review using ICD-9-CM, ICD-10-CM/PCS, DRG validation (3Mcoding software) utilizing appropriate coding references for CHS hospitals via scanned, electronic and hybrid medical records.
• Will utilize hospital abstracting system for coding validation when applicable.
• Prepares preliminary results for review by the requesting party.
• Reviews DRG change disagreements with the Director, Coding Denials and Appeals.
• Assists in preparation of the final quarterly audit reports for Division VPs, AVPs, facility CEOs, CFOs, Regional HIM Directors, VP of HIIM.
• Provides coder education via email and phone on all audits and uses applicable coding references.
• Maintains productivity levels set forth by the HIIM Department and interdepartmental policy while maintaining a 97% accuracy rate by third party auditors.
• Consults with Director, Coding Denials and Appeals during any audit discrepancies.
• Attends coding workshops as necessary to maintain coding credentials.
• Keeps abreast of regulatory changes affecting coding rules and regulations.
• Maintains proficiency in the Official Coding Guidelines for coding and reporting and the AHA Coding Clinics.
• Other duties as assigned by Director, Coding Denials and Appeals.

Requirements

Education: CDIP or CCDS required and RN Preferred. CCS, RHIA or RHIT preferred. CPMA (Certified Professional Medical Auditor) is a plus.

Experience: A minimum of three –five years ongoing inpatient CDI experience in ICD-9-CM, ICD-10-CM/PCS and DRGs. 3-4 year's Clinical Documentation high level review experience required, with experience in mortality risk, PSI, medical