Provides audits and reviews patient charts, corresponding ICD-10 CM and ICD-10 PCS CPT-4 codes, modifiers, HCPCS CPT codes, and charges for appropriateness
Provides reports to management of findings and recommendations for solutions
Identifies areas of improvement to enhance internal controls and performance
Proactively supports safe patient care and a safe environment
Works with management to educate Coding staff on coding and documentation compliance
Conducts chart audits for compliance assessment and establishes coding policy and procedure
Prepares a report of findings for each audit along with an action plan
Records and monitors corrections to the bill and assists in designing continued education to address deficiencies
Plans and organizes work assignments to complete audits efficiently
Identifies problem situations or inadequate charge reconciliation procedures and documents findings
Keeps management informed of problems or unusual circumstances
Facilitates improvement in the overall quality and completeness of medical records documentation
Requirements
Minimum of 5+ years hospital auditing experience
High school diploma or equivalent
Preferred: Associates degree in Health Information Management or related field
Minimum of one certification: Certified Coding Specialist (CCS); Certified Outpatient Coder (COC); Certified Inpatient Coder (CIC); Registered Health Information Technologist (RHIT); Registered Health Information Administrator (RHIA)
Advanced knowledge of classification and reimbursement systems (e.g., ICD-10 CM, ICD-10 PCS, MS-DRG, APR-DRG, Tricare DRG)
Advanced knowledge of CPT, HCPCS, modifiers, ICD-10 CM, ICD-10 PCS coding
Strong analytical, organizational, and communication skills