Senior Health Information Management Inpatient Coding Auditor

February 18

🌴 South Carolina – Remote

Although this job is listed in South Carolina, this company may be open to hiring remote in other states.

⏰ Full Time

🟠 Senior

🔎 Auditor

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Prisma Health

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Prisma Health is a comprehensive health care provider offering a wide range of medical services to ensure individuals achieve their healthiest state. With numerous locations, advanced technology, and expert specialists, Prisma Health provides accessible and convenient care. Services include primary care, specialized heart, cancer, women's, and children's health, as well as same-day and telehealth options. Prisma Health emphasizes community outreach and education to support overall health and wellness.

10,000+ employees

⚕️ Healthcare Insurance

📋 Description

• Knowledgeable and compliant with Prisma Health's values of compassion, dignity, excellence, integrity and teamwork. • Responsible for coder training, work queue management, performing second-level coding reviews utilizing auditing software and documenting findings to improve MCC/CC, HAC/PSI, HCC and Quality Indicator validation. • Performs inpatient coding by assigning ICD-CM and ICD-PCS codes as well as DRG assignment. • Conducts review and audit of discharged inpatient records (prebill and retrospective reviews) to validate the coding/DRG assignment according to official coding guidelines as supported by the clinical documentation in the record. • Monitor work queues daily to identify, prioritize and assign accounts that need to be coded based on department-specific guidelines and within designated timelines in coordination with leadership. • 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 to send to clinical providers. • Maintains working knowledge of Centers for Medicare & Medicaid Services (CMS) regulations and applicable carrier local medical review policies. • Consults, provides professional expertise to and collaborates with clinical documentation specialists on coding and documentation practices and standards. • Collaborates with Coding and CDI to develop and maintain coding curriculum and training materials. • Assists with and develops educational programs for coding staff, clinical documentation staff and medical staff to including yearly coding/DRG updates. • Applies ICD and ICD-PCS codes including major traumas, and Neonatal Intensive Care Unit (NICU) records based on review of clinical documentation. • Verifies assignment of DRGs, MCC/CCs, Hospital Acquired Conditions (HACs) and Patient Safety Indicators (PSIs) that most appropriately reflect documentation of the occurrence of events, severity of illness, and resources utilized during the inpatient encounter and in compliance with department policies and procedures. • Identifies and assists management with the resolution of coding issues, process improvement and system testing for HIM applications. • Interacts with other departments to resolve coding issues and assists with coding and clinical validation denials. • Participates in on-site, remote and/or external training workshops and training. Attends and participates in CDI-Coding Task Force and other collaborative training and education with CDI, PFS, Specialty areas and Quality; perform other duties as assigned.

🎯 Requirements

• Education - Associate's degree or Coding Certificate through approved American Health Information Management (AHIMA) or other coding certification program. • Experience - 4 years - Four (4) years of experience in in-patient coding and abstracting with healthcare billing process experience in acute care setting. • Work experience may NOT substitute for education requirement. • 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.