[Hiring] Clinical Coding Auditor @Texas Health Resources

Role Description

• Medical Records Auditing According to the Audit Scope and Focus
  • Validates accuracy of assigned ICD-10-CM and PCS codes and DRG grouping.
  • Validates accuracy of assigned HCPCS, CPT-4 and APC grouping secondary diagnoses and procedures.
  • Validates the assignment of medically necessity narrative diagnoses as required for specific inpatient medical coverage policies including communication with clinical and/or physician.
  • Assesses the use and quality of coding queries; reports non-compliance with regulatory and/or department standards.
  • Monitors coder trends and patterns for education opportunities and/or physician and clinical documentation improvement needs.
  • Maintains DRG change accuracy of 95%.
  • Supports CCDI department as Coding Reimbursement & Audit team as Subject Matter Experts (SME) in ICD-10-CM and PCS reporting.
• Data Capture and Reporting
  • Utilizes departmental audit databases and/or software accurately to ensure audit data is robust and accurate to relay coded data accuracy.
  • Prepares detailed reports by use of Excel, Excel pivot tables and/or other software as provided; continuously improves on trend identification and capture for optimal reporting.
  • Provides ad hoc and/or additional data to support identification and feedback of opportunities to leadership.
  • Identifies and reports opportunities for process improvement.
  • Captures meeting minutes, follow ups and action plans as required according to audit scope.
  • Recommends refinement and implementation of methods and procedures used for coder and physician education and training; creates and shares tips and audit team education to support department collaboration and efficiency.
  • Provides adequate data to facilitate the identification of development of actions.
  • Updates and develops team policies and procedures to optimize processes; recommends practices to maintain standards for correct coding.
• Fiscal Management of Coding Resources and Processes
  • Consistently meets team KPI goals to support department and system revenue and quality targets.
  • Responds to changes in workload/volumes with team and/or lead communicates when to ensure coverage adjusts for optimal coverage volumes.
  • Verifies, researches and/or reviews codes, charges and reimbursement on patient accounts and denials or for service lines.
  • Completes productivity tracking daily; responds and initiates Analyst to Analyst discussions to ensure decisions are collaborative, consistent and accurate.
  • Resolves ITS issues impacting work by collaborative communication with team, vendor, informaticist and/or IT as required.
  • Supports CCDI department as Coding Reimbursement & Audit team as Subject Matter Experts (SME) in ICD-10-CM and PCS reporting.
• Professional Accountability
  • Maintains frequent and regular contact with manager and seeks consultation and guidance when appropriate.
  • Participates in personal annual performance evaluation, providing opportunity for growth and development.
  • Participates in committee work and cross-functional teams as determined by department leadership.
  • Consistently abides by the Standards of Ethical Coding as set by AHIMA and adheres to Official Coding Guidelines; reviews and applies the directives published in the AHA Coding Clinic and CPT Assistant publication and other approved resources.
  • Maintains certification with CE credits. Pursues knowledge and participation in HFMA, AAPC and AHIMA organizations.
  • Maintains knowledge of regulatory requirements, payer coverage determinations; demonstrates initiative in identifying areas requiring further research.
  • Completes all department and system hospital required training and education according to schedule; maintains all required certification(s) and continuing education requirements.
  • Meets audit, project and task deadlines.
  • Serves as a subject matter expert in areas of documentation, ICD-10-CM and PCS coding with proficiency in CPT-4, HCPCS and modifier assignment.

Qualifications

• Bachelor's Degree in Health Information or related field (Preferred)
• Associate's Degree in Health Information or related field (Required)
• H.S. Diploma or Equivalent with 5 years of acute care and/or relevant experience may be substituted in lieu of degree (Required)

Requirements

• 5 Years Acute care inpatient or CPT surgical level coding (Required)
• 1 Year Performing coding and documentation audits (Preferred)

Licenses and Certifications

• RHIA - Registered Health Information Administrator (12 Months Required)
• RHIT - Registered Health Information Technician (12 Months Required)
• CCS - Certified Coding Specialist (12 Months Required)
• COC - Certified Outpatient Coder (12 Months Preferred)

Skills

• Thorough knowledge of ICD 10-CM, PCS and CPT.
• Expert in coding convention/automated encoder (knowledge management of NCCI/OCE billing edits).
• Practiced in APC and DRG methodologies and regulatory/payer requirements associated with coding.
• Ability to interpret and apply coding and regulatory policy to coding practice and record review process.
• Must demonstrate efficient time management and organizational skills.
• Clear and concise oral and written communication skills.
• Strong decision-making and problem-solving skills are required.
• Proficiency in software applications (Excel, Word, PPT, SharePoint, Optum CAC, EPIC) and strong data analysis capability and report composition skills is preferred.

Supervision

• This position manages people.

ADA Requirements

• Extreme Heat 1-33%
• Extreme Cold 1-33%
• Extreme Swings in Temperature 1-33%
• Extreme Noise 1-33%
• Working Outdoors 1-33%
• Working Indoors 67% or more
• Mechanical Hazards 1-33%
• Electrical Hazards 1-33%
• Explosive Hazards 1-33%
• Fume/Odor Hazards 1-33%
• Dust/Mites Hazards 1-33%
• Chemical Hazards 1-33%
• Toxic Waste Hazards 1-33%
• Radiation Hazards 1-33%
• Wet Hazards 1-33%
• Heights 1-33%
• Other Conditions 1-33%

Physical Demands

• Light Work

Travel Requirements

• Local 10% Occasional travel to THR corporate campus for required education/meetings or IT/equipment needs, etc.