Outpatient Coding Compliance Auditor - FT - Days - Remote Eligible

Responsible for auditing coded inpatient or outpatient medical records applying ICD-10 CM/PCS and/or CPT-4. Reviews Ambulatory Payment Classification (APC), Medicare Severity Diagnosis Related Groups (MSDRG) and All Patients Refined Diagnosis Related Groups (APRDRG) assignment and queries following official coding guidelines and regulatory requirements. Provides training and education based on audit results and any regulatory changes that effect Federal, State and American Health Information Management Association (AHIMA) guidelines.

Responsibilities

Maintains strict adherence to patient confidentiality according to MHS standards and regulatory requirements; Works closely with inpatient and outpatient coding managers to analyze and resolve claim denials that are rejected by edits from the Revenue Cycle Department; Reviews and responds to all external coding denial audits using ICD-10CM/PCS, CPT and APC, MSDRG, and APRDRG audits; Conducts and reports on electronic medical record audits to verify ICD-10CM/PCS, CPT and APC, MSDRG, and APRDRG coding and grouping accuracy; Serves as an expert resource for all coding staff; Assists with developing specific departmental goals, standards, and objectives which directly support the strategic plan and vision of the organization; Maintains thorough knowledge of ICD-10CM/PCS, and CPT coding principles and guidelines; possesses substantial knowledge of MSDRG, APRDRG, APC, and Enhanced Ambulatory Patient Groups (EAPG) classification systems and query guidelines for compliant provider documentation; Coordinates, develops, and implements coder intern education and training; Training will align with AHIMA standards of ethical coding and official coding guidelines; Provides feedback based on audit results and tracks coder intern progression throughout the program; Holds educational sessions for coding specialists, documentation specialists, and physicians; Acts as a liaison for electronic physician query process; Utilizes coding audit results to tailor education to increase coding accuracy; Assists the coding staff to format compliant queries and assesses for compliance with AHIMA query standards; Reports results of coding and query compliance audits to management; Performs all other duties as assigned

Requirements

Accredited Program: Health Information Management (Required); Certified Coding Specialist (CCS) - American Health Information Management Association (AHIMA); Registered Health Information Administrator (RHIA) - American Health Information Management Association (AHIMA); Registered Health Information Technician (RHIT) - State of Florida (FL); For Hospital Coding: Registered Health Information Administrator (RHIA) or Registered Health Information Technician (RHIT) or Certified Coding Specialist (CCS); For Physician Coding: CPC – Certified Professional Coder, HCC - Hierarchical Condition Category Coder, CRC – Certified Risk Adjustment Coder, or CPMA Certified Professional Medical Auditor; For inpatient coding auditor, three (3) years of inpatient coding experience; For outpatient coding auditor, three (3) years of outpatient coding experience; Requires critical thinking, decisive judgment, effective written and verbal communication skills; Demonstrates effective time management skills, professional responsibility and fosters teamwork; Able to work with minimal supervision; Must be able to work in a stressful environment and take appropriate action; Ability to accurately assign and sequence ICD-10-CM/PCS and CPT codes to principal diagnosis and procedures, complications and co-morbid conditions to complex inpatient or outpatient encounters such as observation, outpatient surgery and interventional radiology; Provides guidance to other departmental staff in identifying and resolving coding issues or errors; Proficient in basic computer skills including Microsoft Office applications and utilizing a computerized encoder and electronic medical record systems