Memorial Healthcare provides high-quality, personalized health options to meet the evolving needs of the community it serves. The organization provides a wide range of comprehensiv
Inpatient Coding Compliance Auditor
Location
United States
Posted
45 days ago
Salary
0
Seniority
Mid Level
No structured requirement data.
Job Description
Inpatient Coding Compliance Auditor
Memorial Healthcare
Role Description Responsible for auditing coded inpatient or outpatient medical records applying ICD-10 CM/PCS and/or CPT-4. Reviews Ambulatory Payment Classification (APC), Medicare Severity Diagnosis Related Groups (MSDRG) and All Patients Refined Diagnosis Related Groups (APRDRG) assignment and queries following official coding guidelines and regulatory requirements. Provides training and education based on audit results and any regulatory changes that affect Federal, State and American Health Information Management Association (AHIMA) guidelines. - Maintains thorough knowledge of ICD-10CM/PCS, and CPT coding principles and guidelines. - Possesses substantial knowledge of MSDRG, APRDRG, APC, and Enhanced Ambulatory Patient Groups (EAPG) classification systems and query guidelines for compliant provider documentation. - Conducts and reports on electronic medical record audits to verify coding and grouping accuracy. - Serves as an expert resource for all coding staff. - Assists with developing specific departmental goals, standards, and objectives which directly support the strategic plan and vision of the organization. - Works closely with inpatient and outpatient coding managers to analyze and resolve claim denials. - Reviews and responds to all external coding denial audits. - Coordinates, develops, and implements coder intern education and training. - Maintains strict adherence to patient confidentiality according to MHS standards and regulatory requirements. - Holds educational sessions for coding specialists, documentation specialists, and physicians. - Acts as a liaison for electronic physician query process. - Utilizes coding audit results to tailor education to increase coding accuracy. - Assists the coding staff to format compliant queries and assesses for compliance with AHIMA query standards. - Reports results of coding and query compliance audits to management. Qualifications - Accredited Program: Health Information Management (Required) - Certified Coding Specialist (CCS) - American Health Information Management Association (AHIMA) - Registered Health Information Administrator (RHIA) - American Health Information Management Association (AHIMA) - Registered Health Information Technician (RHIT) - State of Florida (FL) Requirements - For inpatient coding auditor, three (3) years of inpatient coding experience. - For outpatient coding auditor, three (3) years of outpatient coding experience. - Registered Health Information Administrator (RHIA) or Registered Health Information Technician (RHIT) or Certified Coding Specialist (CCS) for Hospital Coding. - CPC – Certified Professional Coder, HCC - Hierarchical Condition Category Coder, CRC – Certified Risk Adjustment Coder, or CPMA Certified Professional Medical Auditor for Physician Coding. Benefits - Equal opportunity employer committed to workplace diversity. - Veteran’s Preference to former military, reservists, and military spouses. Working Conditions and Physical Requirements - Bending and Stooping = 40% - Keyboard Entry = 60% - Kneeling = 40% - Lifting or Carrying 0 - 25 lbs Non-Patient = 40% - Pushing or Pulling 0 - 25 lbs Non-Patient = 40% - Reaching = 40% - Sitting = 60% - Standing = 60% - Walking = 60% - Potential Electric Shock = 60%
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