Inpatient Auditor

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Job Summary:

– Full time, permanent, Facility Inpatient Auditor
– Responsible for performing coding quality audits on a wide variety of inpatient services. 
– The position requires this auditor to be highly proficient in the proper assignment of ICD-10-CM, PCS, CPT, HCPCS and modifier codes.
– Demonstrated ability to provide direction to coding staff as it relates to coding integrity, effective and compliant query application and adherence to facility procedures.  

Primary functions:

– Provides written, detailed rationale and supporting evidence for recommendations on audit findings. 

– Delivers educational feedback to coding staff regarding audit findings.

– Provides guidance to coding staff and management in identifying and resolving coding issues.

– Collaborates with the clinical documentation improvement team for conflicts between code assignments. 

– Identifies documentation improvement opportunities that impact coding accuracy. 

– Initiates physician queries for clarification of documentation in the medical record to achieve accurate code assignment and coding integrity.

– Reviews and researches billing edits.

– Assists with DRG denials from payers including researching and writing appeal letters. 

– Ability to interpret Medicare and NCCI guidelines, National and Local Coverage Determinations to support coding compliance. 

– Performs other duties as assigned including training/mentoring of new staff and performing research related to special projects

Other Job Functions:

– Reports results of audits to departments and committees as assigned

– Identifies opportunities for intradepartmental and interdepartmental operational improvements. 

– Participates in coding program related meetings, physician and staff education, staff development, departmental activities and in-service opportunities.

Qualifications:

– Five years progressive coding or coding review experience in an acute care setting, including auditing

– Comprehensive understanding of coding guidelines, Coding Clinics, CPT Assistant, CCI edits, and appropriate coding references along with the ability to employ these coding resources to audit findings.

– Excellent interpersonal verbal and written communication skills to accurately relay information to internal and external customers.

– Excellent organizational skills with ability to trend and track audit findings effectively.

– Excellent problem-solving skills, the ability to work independently, and to perform under pressure in a teamwork manner with diplomacy and tact. 

– Proficient computer and technical skills, along with experience using MS Word, Excel and PowerPoint. 

– American Health Information Management Association (AHIMA) certification required such as RHIA, RHIT or CCS

– An associate’s degree or higher in a health-related discipline

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