[Hiring] HIMS Coding Auditor @Riverside Health System

Role Description

Responsible for maintaining coded data quality through ongoing quality review and assessment of outpatient or inpatient records. Performs audits on accuracy of APC or MSDRGs as well as on quality of medical record documentation needed for accurate coding. Works with DRG and CPT denials from commercial payers and writes appeal letters as indicated.

• Ensures coding compliance.
• Applies all coding guidelines and principles as defined in the Coding Clinic and leading authorities.
• Complies with standardized coding standards, conventions and regulations, corporate compliance standards and reimbursement policies.
• Identifies training needs and provides education to team members.
• May teach or coordinate coding huddles.
• Coaches and mentors staff.
• Performs focused reviews and quality audits.
• Prepares audit reports for leadership.
• Assists coding leadership with reviewing and responding to internal and external coding audits.
• Works with coding leadership in settlement of audit findings as needed.
• Monitors and evaluates the coding functions to ensure effective and efficient coding operations and compliance with established standards, rules and regulations.
• Audits for documentation opportunities to clarify confusing, incomplete or conflicting information and obtain any needed additional documentation if needed.
• Assists patient financial services and clinical documentation improvement team members with questions on coding and billing edits.
• Serves as a clinical coding liaison.
• Analyzes and evaluates documentation issues with consultation from the medical staff, clinical staff, CDI team and other departments as needed.
• Assists leadership with coordination of iCare initiatives related to the hospital coding department.
• Assists with DRG and certain CPT denials from payers as needed and writes appeals as indicated, documenting the denial/audit in denial management tool for tracking and reports.

Qualifications

• High School Diploma or GED (Required)
• Associates Degree, Healthcare or Related (Preferred)
• 5-6 years Acute Care Inpatient (IP) and Outpatient (OP) Coding (Required)
• 2 years Auditing - Acute Care IP and OP (Required)
• 1 year Clinical Documentation Integrity (Preferred)
• Certified Coding Specialist (CCS) - The American Health Information Management Association (AHIMA) Upon Hire (Required)
• Registered Health Information Administrator (RHIA) - The American Health Information Management Association (AHIMA) Upon Hire (Preferred)
• Registered Health Information Technician (RHIT) - The American Health Information Management Association (AHIMA) Upon Hire (Preferred)
• Certified Cardiac Device Specialist (CCDS) - International Board of Heart Rhythm Examiners CCDS or CDIP Clinical Documentation Improvement Professional Upon Hire (Preferred)
• Certified Professional Coder (CPC) - American Academy of Professional Coders (AAPC) Upon Hire (Preferred)

Company Description

To learn more about being a team member with Riverside Health System visit us at Riverside Health System Careers .