Medical Coding Auditor

Job Summary:

• Conducts data quality audits of inpatient admissions and outpatient encounters to validate coding assignment complies with the official coding guidelines as supported by clinical documentation in health records.
• Validates abstracted data elements that are integral to appropriate payment methodology.

Responsible for effectively communicating information and audit findings through presentations, graphs, reports, and educational materials, etc. Job Responsibilities/Duties:

• · Chart Analysis IP, OP Coding Data auditing and validation: Reviews medical records for the determination of accurate assignment of all documented diagnoses and procedures.
• Adheres to Standards of Ethical Coding (AHIMA).
• Reviews medical records for the determination of accurate assignment of all documented diagnoses and procedures.
• Reviews claim to validate abstracted data including but limited to discharge disposition which impacts facility reimbursement and/or MS-DRG assignment.
• Adheres to Standards of Ethical Coding (AHIMA).

Reviews medical records to determine accurate required abstracting elements (facility/client/payer-specific elements) including appropriate discharge disposition · IP, OP Coding:

• Reviews medical records for the determination of accurate assignment of all documented ICD-10-CM codes for diagnoses and procedures.

Abstracts accurate required data elements (facility/client specific elements) including appropriate discharge disposition. · Coding:

• Uses discretion and specialized coding training and experience to accurately assign ICD-10, CPT-4 codes to patient medical records. · Abstracting: Reviews medical records to determine accurate required abstracting elements (client specific elements) including appropriate discharge disposition. · Coding Quality: Demonstrates ability to achieve accuracy and consistency in the selection of principal and secondary diagnoses (including MCC & CC) and procedures.

Demonstrates ability to achieve accuracy and consistency in abstracting elements defined by SOW. · Professional Development:

• Stays current with AHA Official Coding and Reporting Guidelines, CMS and other agency directives for ICD-10-CM and CPT coding.
• Attends mandatory coding seminars on an annual basis (IPPS and OPPS, ICD-10-CM, and CPT updates) for inpatient and outpatient coding.
• Quarterly review of AHA Coding Clinic.

Attends Quarterly Coding Updates and all coding conference calls · Create audit schedules and manage workflows to adhere to the audit schedule. · Develop methods to effectively communicate information through presentations, graphs, reports, educational materials, etc. · Develop, establish, and review policies and objectives consistent with those of the organization to ensure efficient departmental operations. · Performs charge audits by comparing itemized bills to medical record documentation to ensure appropriate charging. · Review, assess, study, and analyze the overall coding, billing, documentation, and reimbursement system for potential compliance problems. · Performs all other duties as assigned. Qualifications & Experience:

• · Ability to consistently code at 95% accuracy and quality while maintaining client-specified production standards · Must successfully pass a coding test · Knowledge of medical terminology, ICD-9-CM and CPT-4 codes · Must be detail-oriented and can work independently · Computer knowledge of MS Office · Must display excellent interpersonal skills · The coder should demonstrate initiative and discipline in time management and assignment completion · The coder must be able to work in a virtual setting under minimal supervision · Intermediate knowledge of disease pathophysiology and drug utilization · Intermediate knowledge of MS-DRG classification and reimbursement structures · Intermediate knowledge of APC, OCE, NCCI classification and reimbursement structures EDUCATION / EXPERIENCE · Associate degree in a relevant field preferred or a combination of the equivalent of education and experience · Three years of coding experience including hospital and consulting background CERTIFICATES, LICENSES, REGISTRATIONS · AHIMA Credentials, and or AAPC · Certified Professional Medical Auditor by AAPC PHYSICAL DEMANDS · Requires visual acuity to inspect and analyze work close to the eyes and ability to hear sound with or without correction; Ability to climb, stoop, kneel, reach, stand, walk pull, push lift, and able to exert up to 40 pounds of force occasionally and/or up to 10 pounds of force constantly to move objects. · Moderate physical activity performing somewhat strenuous daily activities of a primarily administrative nature. · The physical demands for this position include adequate vision, hearing, and repetitive motion. · Ascending or descending stairs, ramps, and the like, using feet and legs and/or hands and arms. · Substantial movements (motion) of the wrist, hands, and/or fingers in a repetitive manner - Bending legs downward and forward by bending leg and spine - Standing, particularly for sustained periods of time.

Using upper extremities to exert force to draw, drag, haul or tug objects in a sustained motion. · Raising objects from a lower to a higher position or moving object horizontally from position to position WORK CONDITIONS • While performing the duties of this job, the employee is frequently required to stand, walk, sit, reach with hands and arms, and talk or hear. • The employee is occasionally required to stoop, kneel, crouch, or crawl and taste or smell. • The employee is required to have close visual acuity to perform an activity such as:

• preparing and analyzing data and figures, transcribing, and viewing a computer terminal.
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