JOB SUMMARY :
The Coding Auditor provides auditing services across clients in Inpatient chart types and code sets. The incumbent reviews documentation and related coding, auditing correct assignment of ICD-
10-AM, ACHI, CPT, HCPCS and any other coding classification to verify coding and billing accuracy and ensure that coders base code assignment is in a manner consistent with relevant laws, regulations, coding and billing standards.
The Coding Auditor will provide education to Clinical Coders on audit results, utilize expertise to research and respond to challenging coding questions, develop and provide coding education and evaluate audit results to recommend corrective actions.
The Coding Auditor will have the expertise to respond to client requests to conduct ad hoc Inpatient coding and billing audits.
Coding Auditor will be responsible for assisting with developing all education and coding quality improvement initiatives for the Inpatient Coding Division at Sidra.
The Coding Auditor is responsible for analyzing, reviewing, and resolving coding and documentation issues that are related to reimbursement, compliance, and revenue enhancement.
He / she investigates and resolves problems, complaints and incidents occurring within the coding section and assists the Manager Coding with resolution of such issues.
The Coding Auditor position has an extensive background in inpatient coding and reimbursement guidelines and specifically has a solid understanding of the MS-
DRG, AP-DRG and APR-DRG payment systems. This position is responsible for auditing client data and generating high quality recoverable claims for the benefit of Sidra and our clients.
KEY ROLE ACCOUNTABILITIES :
Audits medical record documentation to identify under coded and upcoded services; prepares reports of findings and meets with providers to provide education and training on accurate coding practices and compliance issues.
Provides second-level review of billing performances to ensure compliance with legal and procedural policies and to ensure optimal reimbursements while adhering to regulations prohibiting unbundling and other questionable practices.
Documents relevant trends of inaccurate coding and areas that are high risk for compliance issues to the Coordinator. Responsible for offering recommendations for improvement to maintain a minimum of 95% coding quality across Sidra.
Clearly documents audit findings and calculate billing error rates. Provides feedback and education as appropriate depending on findings.
Articulates audit findings appropriate for audience. Prepares written audit reports as needed summarizing audit findings and any corrective action necessary to mitigate risk.
Plans and develops an effective Clinical coding Audit programme.
Develops and implements coding strategies, policies and procedures across the organization.
Assists the development of a clinical coding training programme for staff and mentor staff.
Researches, analyzes, and responds to inquiries regarding compliance, inappropriate coding, denials, and billable services.
Responsible for performing coding reviews of inpatient medical records and other documentation to evaluate issues related to coding accuracy.
In addition, this role will have some training related to reviewing clinical indicators, medical necessity, and the appropriateness of treatment setting and services delivered.
Primarily responsible for auditing efforts by executing projects assigned by the Director, Audit Operations or Manager, Audit Operations.
Displays professional scepticism that enhances the work performed in order to achieves success in position.
Comprehensive knowledge of coding practices and procedures to include Coding Clinic guidelines and the guidelines of other authoritative groups who oversee the accuracy and compliance of coding.
obtains clarification of conflicting, ambiguous, or non-specific documentation.
Trains, instructs, and / or provides technical support to medical providers and medical coding analysts as appropriate regarding coding compliance documentation, and regulatory provisions, and third party payer requirements.
Reviews, develops, modifies, and / or adapts relevant client procedures, protocols, and data management systems to coordinate these with SMRC methodology, to ensure that client billing operations meet the joint requirements of both the local facility and UPA.
Interacts with providers and management to review and / or implement codes and to update charge documents.
Stays abreast of relevant Inpatient coding and billing guidelines
Researches, develops and presents education to coders
Conducts auditor peer review audits, as requested
Assists with special projects assigned by the Manager, Inpatient Education & audits.
Adheres to Sidra’s standards as they appear in the Code of Conduct and Conflict of Interest policies
Adheres to and promotes Sidra’s Values
In view of the evolving needs and opportunities within Sidra, this position may be required to perform other duties as assigned and reporting relationships may vary.
QUALIFICATIONS, EXPERIENCE AND SKILLS SELECTION CRITERIA :
Bachelor’s Degree in a relevant field or equivalent
5+ years’ experience in coding clinical information systems inclusive of 2+ years senior lead experience in HIM / Coding
Credentialed Coder Certificate (CPC, CCS), Registered Health Information Certificate (RHIT, RHIA)
Inpatient Coding experience
Inpatient Coding Audit experience
Familiarity with the revenue cycle as it relates to inpatient coding, auditing and billing
Extensive experience with various documentation and Electronic Medical Records
Extensive experience in all Inpatient chart types and in high level trauma facilities
Ability to use office equipment and automated systems / applications / software at an acceptable level of proficiency
Proficiency with Microsoft Office suite
Fluency in written and spoken English
3M Coding Encoder experience