[Hiring] Coding Quality Review Auditor @Adventist Health

Role Description

Performs quality reviews and audits to ensure compliance with DRG validation, ICD-10/PCS, and CPT coding guidelines. Coordinates with department leadership to ensure standards are met in accordance with department and organization policy. Contributes to improving the processes and infrastructure of the department. Demonstrates proficiency in facilitation and interpersonal communication, organizational skills, prioritization of tasks, professionalism, and educating and training as required. Uses in-depth understanding of the CQR quality workplan to promote compliance and awareness of the plan. Acts as a subject matter expert (SME) in national coding guidelines for hospital inpatient, outpatient, and/or Professional fee coding and ensures compliance with those guidelines along with all company coding policies. Uses performance improvement analyses to improve the accuracy, integrity, and quality of patient data, ensure minimal variation in coding practices, and improve the quality of physician documentation within the body of the medical record to support code assignments which results in appropriate reimbursement and data integrity.

Qualifications

• High School Education/GED or equivalent: Required
• Associate’s/Technical Degree or equivalent combination of education/related experience: Preferred
• Five years' acute care inpatient, outpatient coding experience, and/or professional fee coding: Required
• Three years' coding auditing/monitoring experience: Preferred
• Certified Coding Specialist credential (CCS) through AHIMA or AAPC; credential type specific to auditing being performed: Required

Requirements

• Performs regularly scheduled quality reviews and audits per departmental policies and procedures (routine, pre-bill, policy driven, targeted, and post-bill) for hospital inpatient, outpatient, and/or professional fee coding.
• Facilitates the coder audit appeal process, providing rationale and education to the coding team as required.
• Performs ad hoc quality reviews, such as targeted DRG reviews, and special projects as assigned by management.
• Prepares detailed audit reports outlining findings, recommendations, rationale, and corrective actions needed.
• Facilitates the coder appeal process.
• Assists team members with coding questions and provides resolution guidance.
• Assists in ensuring coding staff adherence with coding guidelines and policy, both internal and vendor teams.
• Demonstrates and applies expert level knowledge of medical coding practices and concepts.
• Communicates appropriately with manager and all stakeholders as required.
• Identifies and communicates educational opportunities to manager.
• Maintains working knowledge of workflows, systems, and tools used in the department.
• Reviews all official data quality standards, coding guidelines, company policies and procedures, and clinical/medical resources to assure coding knowledge and skills remain current.
• Maintains up-to-date knowledge of medical terminology, coding guidelines, quality standards, regulatory changes, etc. that affect the audit process.
• Assists in creation and maintenance of a positive working environment, including effective communication and setting an appropriate professional example.
• Performs other job-related duties as assigned.

Company Description

Adventist Health is a faith-based, nonprofit, integrated health system serving more than 100 communities on the West Coast and Hawaii with over 440 sites of care, including 27 acute care facilities. Founded on Adventist heritage and values, Adventist Health provides care in hospitals, clinics, home care, and hospice agencies in both rural and urban communities. Our compassionate and talented team of more than 38,000 includes employees, physicians, Medical Staff, and volunteers driven in pursuit of one mission: living God's love by inspiring health, wholeness and hope.