Coding Quality Auditor

Job Duties & Responsibilities

·         Provides internal coding quality reviews to ensure compliance with official coding guidelines for hospital coding

·         Applies ethical coding principles (CMS, AMA, CPT, ICD-10-CM), HCC coding standards, and revenue cycle knowledge to assess coding accuracy and billing integrity

·         Reviews and audits post-billed inpatient charts to ensure that the ICD-10 and ICD-10-PCS codes accurately reflect the documentation, patient acuity and level of care provided for the specific admission

·         Recognizes and reviews patterns with the CDIs for provider education

·         Identifies coding trends based on payer denials, rejections, and claim edits

·         Presents audit findings bi-monthly to the team and educates the team based on findings

·         Reviews work completed by the coder, and if the coder is in error, returns to the coder with education to complete

·         Obtains required number of CEUs for current certification and completes required education

·         Identifies incorrect admit/discharge dates and patient type and sends to the appropriate department to update

·         Covers any open work queues (WQs) during end of month push or when a supervisor or manager requests 
 

Skills & Requirements

·         High school diploma/GED required

·         RHIA – Cert – Reg Health Info Admin or RHIT – Cert – Reg Health Info Tech by American Health Information Management Association (AHIMA) required

·         CPC – Certified Professional Coder by American Academy of Professional Coders (AAPC) required

·         CPMA – Cert – Professional Medical Auditor by American Academy of Professional Coders (AAPC) preferred

·         5 years of DRG coding, professional billing or hospital billing experience required

·         1 year of auditing IP experience preferred