Coding Denials Auditor
Inpatient Coding Denials Auditor - Remote
EDUCATION: CCS, RHIA or RHIT required. CPC and CPMA (Certified Professional Medical Auditor) is a plus.
A minimum of three –five years on going inpatient coding and abstracting experience in ICD-9-CM, ICD-10-CM/PCS and DRGs. A minimum of two years auditing experience.
SYSTEMS: 100% 3M 360 CAC & Encoder; Cerner, eCharms, Legacy
Medhost abstracting, (HMS)
Performs inpatient coding DRG denial audits of RAC and non-RAC payer accounts, for the HIIM Department at the Corporate office. Reviews patient records for accuracy in ICD-9-CM coding, ICD-10-CM/PCS, DRG assignment, present on admission indicators (POA), discharge disposition and any other pertinent data needed to capture coding accuracy. Provides audit feedback via the auditing process to pertinent parties, i.e. HIM Director, Corporate Coding Manager, etc.. Assists in preparation of the monthly and quarterly denials audit reports. Applied knowledge of medical terminology, pathophysiology, and pharmacology. Demonstrates tested data quality and integrity skills.
- Performs inpatient coding audits using ICD-9-CM, ICD-10-CM/PCS, DRG validation (3Mcoding software) utilizing appropriate coding references via scanned, electronic and hybrid medical records.
- Will utilize hospital abstracting system for coding validation when applicable.
- Prepares preliminary results for review by the requesting party.
- Reviews DRG change disagreements with the Director, Coding Denials and Appeals.
- Assists in preparation of the final quarterly audit reports for Division VPs, AVPs, facility CEOs, CFOs, Regional HIM Directors, VP of HIIM.
- Provides coder education via email and phone on all audits and uses applicable coding references.
- Maintains productivity levels set forth by the HIIM Department and interdepartmental policy while maintaining a 97% accuracy rate by third party auditors.
- Consults with Director, Coding Denials and Appeals during any audit discrepancies.
- Attends coding workshops as necessary to maintain coding credentials.
- Keeps abreast of regulatory changes affecting coding rules and regulations.
- Maintains proficiency in the Official Coding Guidelines for coding and reporting and the AHA Coding Clinics.
- Other duties as assigned by Director, Coding Denials and Appeals
- Thorough knowledge of the related inpatient prospective payment systems (IPPS)
- Experience in working DRG coding denials and writing appeal letters to government and non-government payers
- Experience preserving coding integrity based on Coding Guidelines, Coding Clinic and appropriate coding references and resources
- Broad knowledge of pharmacology indications for drug usage and related adverse reactions
- Knowledge of anatomy, physiology and medical terminology
- Understanding of coding practices and official guidelines
- Experience with PC, mainframe applications, and encoding systems
- Auditing skills for coding quality and compliance
- Strong process management skills