Health Information Management Inpatient Coding Auditor

6 days ago

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Prisma Health

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10,000+

Description

• Responsible for leading coding teams, coder training, work queue management. • Performing prebill and second-level coding reviews utilizing auditing software. • Uses knowledge of coding and compliance guidelines to identify potential documentation, coding and reimbursement issues. • Employ critical thinking skills to alert coding leadership to any trends identified in their reviews. • Reviews and responds to inpatient denials as needed. • Conducts review and audit of discharged inpatient records to validate the coding/DRG assignment. • Monitor work queues daily to identify, prioritize and assign accounts. • Mentors and trains coders on application of correct ICD-CD and ICD PCS guidelines. • Coordinates and identifies provider documentation queries for the Clinical Documentation Integrity team. • Maintains working knowledge of CMS regulations and applicable carrier local medical review policies. • Consults and collaborates with clinical documentation specialists on coding practices. • Assists with and develops educational programs for coding staff.

Requirements

• Associate's degree or Coding Certificate through approved American Health Information Management (AHIMA) or other coding certification program. • Four (4) years of experience in in-patient coding and abstracting with healthcare billing process experience in acute care setting. • Required Certifications, Registrations, Licenses: Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), Certified Coding Specialist (CCS), Certified Inpatient Coder (CIC) or other approved coding credential. • Knowledge of electronic medical records and 3M or Encoder System. • EPIC health information system experience. Preferred. • Strong knowledge of medical terminology and basic anatomy and physiology, pathophysiology, and pharmacology with the ability to apply this knowledge to the coding process. • Knowledge of MS DRG prospective payment system and severity systems. • Knowledge of Clinical Documentation Improvement principles, quality indicators, formal and informal coding audit process. • Ability to work effectively, independently and manage multiple demands consistently. • Proficient computer skills (spreadsheets and database).