Coding Quality Auditor

At Houston Methodist, the Coding Quality Auditor position is responsible for ensuring accuracy in code assignment of diagnosis and procedure to outpatient and / or inpatient encounters based upon documentation within the electronic medical record while maintaining compliance with established rules and regulatory body guidelines. This position performs data quality review to ensure data integrity, coding accuracy, and revenue preservation. Additional duties include participating in quality review and performance improvement projects throughout the department and / or facility.

FLSA STATUS

Non-exempt

QUALIFICATIONS

EDUCATION

• Associate's degree or higher in a Commission on Accreditation in Health Informatics and Information Management accredited program required or additional two years of experience (in addition to the minimum experience requirements listed below) required in lieu of degree

EXPERIENCE

LICENSES AND CERTIFICATIONS

Required

For inpatient / outpatient coding : RHIT, RHIA, or CCS certification from AHIMA is required

For professional fee coding : CPC from AAPC is required

SKILLS AND ABILITIES

Demonstrates the skills and competencies necessary to safely perform the assigned job, determined through on-going skills, competency assessments, and performance evaluations

Sufficient proficiency in speaking, reading, and writing the English language necessary to perform the essential functions of this job, especially with regard to activities impacting patient or employee safety or security

Ability to effectively communicate with patients, physicians, family members and co-workers in a manner consistent with a customer service focus and application of positive language principles

Knowledge of an electronic medical record and imaging systems

Working knowledge of medical terminology, anatomy and physiology

Proficiency with electronic encoder application

AHIMA designated ICD-10 Approved Trainer preferred

ESSENTIAL FUNCTIONS

PEOPLE ESSENTIAL FUNCTIONS

Interacts and communicates effectively with members of the coding team and HIM, physicians, CDMP nurses, IT, Quality Operations, Case Management, Patient Access and Business Office.

Participates and provides good feedback during coding section meetings, coding education in-services, and coder / CDMP meetings. Takes initiative to assist others and shares knowledge with the coding group and business partners on official coding guidelines.

SERVICE ESSENTIAL FUNCTIONS

Responds promptly to internal and external customer coding / DRG requests. Responds promptly to Business Office requests to code or review coded accounts for accuracy. Identifies and anticipates customer requirements, expectations, and needs. Provides assistance to the leadership team or other coders with coding of the accounts or answering questions from other coders relating to coding and work flows.

Initiates queries with physicians to obtain or clarify diagnoses and / or procedures as appropriate, utilizing the established physician query process. Provides assistance to Clinical Documentation Management Program (CDMP) with appropriate MS-DRG and APR-DRG assignment, sequencing of diagnoses and procedures, and coding and documentation training.

Assists with quality assurance (peer) reviews to ensure data integrity and accuracy of coding, identifies opportunities for improvements, and makes recommendations for optimal enhancements.

Assists Case Management and Patient Access Departments in providing appropriate CPT codes for pre-admission and pre-certification requirements including the inpatient only process. Assists in the development of documentation protocols for physicians. Represents the coding area in Hospital meeting / events when necessary (e.g., Performance Improvement Committees).

QUALITY / SAFETY ESSENTIAL FUNCTIONS

Maintains and achieves the highest standards of coding quality by assigning accurate ICD-9-CM / ICD-10-CM / ICD-10-PCS and CPT codes utilizing an electronic encoder application in accordance with hospital policy and regulatory body guidelines.

Performs accurate, optimal DRG and APC assignment, in accordance with nationally established rules and guidelines based upon documentation within the medical record.

Reviews discharge disposition entered by nursing and corrects if necessary in order to achieve the highest quality of entered data.

Assigns and enters physician identification number and procedure date correctly in the medical record abstracting system. Reviews medical record documentation and abstracts data into the encoder and Electronic Health Record (EHR) abstracting system to determine principal or final diagnosis, co-morbid conditions and complications, secondary conditions and procedures.

Assists with quality reviews of outpatient or inpatient accounts and / or training of new coders. Complies with the Standards of Ethical Coding as set forth by the American Health Information Management Association (AHIMA) and adheres to official guidelines.

Aggregates data from reviews and compiles reports for HIM management.

FINANCE ESSENTIAL FUNCTIONS

Utilizes time effectively. Consistently codes and abstracts at departmental standards of productivity while ensuring accuracy of coding. Ensures work flows and worklists are reviewed or monitored in order to identify old uncoded accounts or problem accounts.

Assists in making sure coding bill hold goal is met. Maintains coding timeframes within acceptable guidelines by ensuring all work items assigned to the coding queues and worklists are processed in a timely manner.

GROWTH / INNOVATION ESSENTIAL FUNCTIONS

SUPPLEMENTAL REQUIREMENTS

WORK ATTIRE

Uniform : No

Scrubs : No

Business professional : Yes

Other (department approved) : No

ON-CALL

TRAVEL

Travel specifications may vary by department

May require travel within the Houston Metropolitan area Yes

May require travel outside Houston Metropolitan area Yes

Company Profile :

Houston Methodist is one of the nation's leading health systems and academic medical centers. The health system consists of eight hospitals : Houston Methodist Hospital, its flagship academic hospital in the Texas Medical Center, seven community hospitals and one long-term acute care hospital throughout the Greater Houston metropolitan area. Houston Methodist also includes a research institute; a comprehensive residency program; international patient services; freestanding comprehensive care clinics, emergency care and imaging centers; and outpatient facilities. Come lead with us!