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Clinical Coding Auditor
<Undefined>Clinical Coding Auditor at Texas Health Resources validating and auditing medical coding. Supporting coding compliance and accuracy while optimizing processes for health information management.
About the role
Key responsibilities & impact- 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.
- 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 to 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
- 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 and review 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 team ensure decisions are collaborative, consistent and accurate.
- Resolves ITS issues impacting work by collaborative communication with team, vendor, informaticist and/or IT as required.
- 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 of 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 expert in areas of documentation, ICD-10-CM and PCS coding with proficiency in CPT-4, HCPCS and modifier assignment.
Requirements
What you’ll need- Bachelor's Degree Health Information or related field Preferred
- Associate's Degree Health Information or related field Required
- H.S. Diploma or Equivalent 5 Years Years of acute care and/or relevant experience may be substituted in lieu of degree Required
- 5 Years Acute care inpatient or CPT surgical level coding Required
- 1 Year Performing coding and documentation audits Preferred
- 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 Required
- 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
Benefits
Comp & perks- Health insurance
- Professional development
- Occasional travel for education/meetings
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
ICD-10-CMPCS codingCPT-4HCPCSAPC groupingDRG groupingcoding auditscoding queriesdata analysisproductivity tracking
Soft Skills
communicationcollaborationtime managementorganizational skillsproblem-solvingattention to detailleadershipadaptabilitycritical thinkingreporting
Certifications
RHIARHITCCSCOCCE creditsAHIMA certificationHFMA membershipAAPC membership