Coding Compliance Auditor

Job Description This is a remote position. PLEASE NOTE: It is a remote position. Schedule: Full-time. Shift hours can be flexible and discussed with the manager. The core business hours are 6.00 AM - 6.00 PM Must be based in EST or CST hours (cannot recruit from Hawaii, Alaska, or California). Assessment will be given to qualified candidates identified by client. Assessment will need to be completed and scored before proceeding with interview Must have their own equipment to work from. Must have reliable internet and a secure work environment. Interviews could be web ex or teams. Temp to hire. Coversheet is required when submitting candidates JOB SUMMARY: Accurately audits hospital Inpatient, Ambulatory Surgery, Observation, and any other outpatient encounter visit for the purpose of appropriate reimbursement, research and compliance with federal and state regulations according established ICD-10-CM/PCS coding and/or CPT-4 procedure coding classification systems. JOB RESPONSIBILITIES: KEY RESPONSIBILITY 1: Serves as a clinical coding subject matter expert, and utilizes critical thinking analyze and evaluate documentation issues with consultation from the medical and clinical staff, and clinical documentation specialists as needed. Audits ICD-10 diagnostic codes and CPT-4 procedure codes outpatient, ambulatory surgery, and observation visits for the purpose of reimbursement, research and compliance with federal and state regulations. Audits complex inpatient cases such as trauma, rehab, neurology, critical care, etc. utilizing the ICD-10-CM and ICD-10-PCS nomenclature ensure accurate APR-DRG/SOI/ROM and POA assignment. KEY RESPONSIBILITY 2: Serves in an advisory and educator role for Coding Specialists. Serves as communicator between Clinical Documentation Specialists and Coding. Researches new surgical procedures and technology. Provides training to new employees Reports coding quality accuracy rate for each coder Monitors productivity rate for each coder Conducts specialized focused audits as needed. Key Responsibility 3: Communicates with various departments within the hospitals regarding coding accuracy. Refers any problems to management timely, providing clear details. Assist coding specialists in writing appropriate coding queries, works collaboratively with CDI, understand Potentially Preventable Complications (PPC’s)/Maryland Hospital Acquired Conditions (MHAC’s), Prevention Quality Indicators (PQI’s) and their impact and other indicators as needed. KEY RESPONSIBILITY 4: Complies with AHIMA standards of ethical coding and coding compliance guidelines. KEY RESPONSIBILITY 5: Demonstrates support and compliance with client mission, vision, values statement, goals and objectives and policies. Performs other duties or projects such as coding corrections as assigned by the manager. Requirements REQUIRED QUALIFICATIONS: EDUCATION: High School graduate or equivalent. Formal ICD-10-CM, ICD-10-PCS, CPT-4 training. Associates or Bachelor’s degree. Education will be considered in lieu of experience. EXPERIENCE: Minimum of two years ICD-10-CM/ICD-10-PCS coding and abstracting experience with at a Level 1 Trauma hospital or 4 years of experience with coding inpatient hospital medical records. 2-3 Years Ambulatory coding experience. Must have inpatient auditing experience CERTIFICATIONS: One of the following: Certified Coding Specialist (CCS) Registered Health Information Technician (RHIT) Registered Health Information Administrator (RHIA) Certified Inpatient Coder (CIC) Education/Work Experience High School graduate or equivalent. Formal ICD-10-CM, ICD-10-PCS, CPT-4 training. Associates or Bachelor’s degree. Education will be considered in lieu of experience.