Coding Auditor Senior Facility

Position Summary:  Responsible for working with and providing on-going coding and documentation education (quarterly, annually and ad-hock) for physicians, coders, ancillary department staff, clinical documentation improvement (CDI), and other allied health professionals to improve documentation of patient care and to appropriately assign codes and/or determine charges to support those services.

Essential Functions and Responsibilities As Assigned:

1.      Completes quality assurance audits on inpatient and outpatient coding specialists, onboarding audits and training of newly hired coding specialists, validating the coding specialist is accurately abstracting data into medical record systems, following coding guidelines and directives.

2.      Validates Present on Admission (POA) indicators according to guidelines and identifies any missing or inappropriate queries to providers.

3.      Uses payment methodology to audit outpatient and/or inpatient facility coding and billing, MS-DRG or APC assignment, and OPPS reimbursement methodology and shares knowledge with colleagues and clinical team members. Senior Auditor will support the Clinical Validation Initiatives with identifying cases for review and resolution, developing guides for the Clinical Validation Guidebook in partnership with CDI for each identified complication or disease during the Clinical Validation Meetings.

4.      Serves as an advisor and support to the Auditor.

5.      Performs retrospective, random, and focused audits of coding cases to ensure accurate code application and overall coding quality.

6.      Performs periodic and ongoing pre-bill compliance audits to ensure accurate code assignment, application of coding guidelines, and compliance with external regulatory and accreditation requirements.