Coding Quality Auditor

At Houston Methodist, the Coding Quality Auditor position is responsible for ensuring accuracy in code assignment of diagnosis and procedure to outpatient and/or inpatient encounters based upon documentation within the electronic medical record while maintaining compliance with established rules and regulatory body guidelines. This position performs data quality review to ensure data integrity, coding accuracy, and revenue preservation. Additional duties include participating in quality review and performance improvement projects throughout the department and/or facility.

Responsibilities

Ensure accuracy in code assignment of diagnosis and procedure to outpatient and/or inpatient encounters based on EMR documentation; Maintain compliance with established rules and regulatory body guidelines; Perform data quality review to ensure data integrity, coding accuracy, and revenue preservation; Participate in quality review and performance improvement projects; Interact and communicate with coding team, HIM, physicians, CDMP nurses, IT, Quality Operations, Case Management, Patient Access and Business Office; Respond promptly to internal and external coding/DRG requests; Initiate physician queries to obtain or clarify diagnoses and/or procedures; Assist with quality assurance (peer) reviews and compile reports for HIM management; Assign accurate ICD-9-CM/ICD-10-CM/ICD-10-PCS and CPT codes using an electronic encoder; Perform accurate DRG and APC assignment; Assist with coding bill hold goals and coding timeframes; Assist with training of new coders

Requirements

Associate's degree or higher in a CAHIIM-accredited program, or two additional years of experience in lieu of degree; Five years of coding experience relevant to the area auditing (e.g., inpatient, outpatient, professional fee); For inpatient/outpatient coding: RHIT, RHIA, or CCS certification from AHIMA; For professional fee coding: CPC from AAPC; Demonstrates the skills and competencies necessary to safely perform the assigned job; Sufficient proficiency in speaking, reading, and writing the English language; Ability to effectively communicate with patients, physicians, family members and co-workers; Knowledge of an electronic medical record and imaging systems; Working knowledge of medical terminology, anatomy and physiology; Proficiency with electronic encoder application

Nice to have

AHIMA designated ICD-10 Approved Trainer preferred