This position is responsible for the coordination of quality audits for coding staff and/or Renown providers. In addition, this position is responsible for auditing as part of the Coding Teams and the reporting of audit results to Leadership, Compliance and other Departmental Leadership when applicable. The emphasis of this position is to coordinate all aspects of audit entities, including outside request for compliance and billing, including and not limited to RAC and/or other auditing programs requests.

This position is responsible in keeping abreast of continual changes in coding and billing guidelines and compliance related to reimbursement within federal and State regulations. This incumbent is to have expert knowledge of accurately assigning ICD-10-CM diagnostic, procedure codes and E/M levels for all aspects of facility or professional coding. This list is to include Acute Inpatient/Outpatient, Level II Trauma, Rehab Facility, Home Health, Hospice, Ambulatory and hospital-based outpatient areas. ICD-10-CM/PCS, CPT and E/M code assignments must be consistent with CMS Official Guidelines, regulatory agencies and hospital specific bylaws and guidelines.

Incumbent is responsible for auditing information coded from provider documentation and patient medical records within the designated time frames in order to expedite the billing process ensure accurate reimbursement for services rendered and to promote compliance. The major challenge of this position is to coordinate the coding staff auditing schedules for quality and proficiency to ensure compliance of Coding/Auditing, Coding and documentation quality, and that accurate reimbursement is being met with quality coding standards.

Incumbent is responsible for ensuring the accuracy and completeness of clinical coding, provide the coding staff with the necessary support for coding guidelines through continuous quality improvement. Proactively identify areas of opportunity to improve coding quality based on audit feedback, coder questions, physician escalations, denial meetings, and other platforms and plans coder education accordingly. Demonstrate the attention to detail to minimize coding errors, legitimately optimize reimbursement and ensure accurate billing.

Specific Job Responsibilities by section include:

Coding Auditor (Facility):

This list is to include but is not limited to auditing, educating and escalating results/trends to Coding Leadership; Acute Inpatient/Outpatient, Level II Trauma, Inpatient Rehab, Home Health, Hospice and hospital-based outpatient departments. Feedback and correction of ICD-10-CM/PCS, CPT codes and DRG assignments must be in alignment with departmental standards of work, facility policy, CMS Official Guidelines and regulatory agencies.

Coding Auditor (Professional Services):

This list is to include but is not limited to auditing, educating and escalating results/trends to Coding Leadership; Renown Primary Care and Specialty Care Groups, Acute Inpatient/Outpatient, Trauma and Inpatient Rehab. Feedback and correction to coders and Renown providers of ICD-10-CM, CPT, HCPCS, E/M code assignments and modifiers must align with departmental standards of work, facility policy, CMS Official Guidelines and regulatory agencies.

Other responsibilities include:

* Conduct audits of medical records to assess the accuracy and completeness of medical coding assignments.

* Review documentation to ensure proper code assignment based on diagnosis, procedures, and services rendered.

* Verify that coding practices comply with current coding guidelines, regulations, and industry standards.

* Adhere to compliance requirements and standards for clinical documentation in accordance with the American Medical Association and the Centers for Medicare and Medicaid Services Coding and Documentation guidelines, regulations of federal and state agencies, and third-party payers.

* Identify coding errors, discrepancies, and potential compliance issues through comprehensive review and analysis.

* Ensure timely completion of monthly audit reviews as established by HIM Coding Leadership.

* Provide feedback and education to coding staff and healthcare providers on coding guidelines, documentation requirements, and compliance issues.

* Perform special audits/chart review and provide written findings to requested HIM Coding Leader.

* Develop and implement best practices and training programs to improve coding accuracy and compliance.

* Stay abreast of updates and changes in coding regulations, reimbursement policies, and healthcare industry trends.

* Generate reports and metrics to track coding audit findings, trends, and compliance metrics.

* Report/record all documentation and coding issues that require follow-up reviews to coding manager.

* Maintain confidentiality and adhere to ethical standards in handling sensitive patient information.

* Balance team and individual responsibilities; be open and objective to other's views; give and welcome feedback; contribute to positive team goals; and put the success of the team above own interests.

The foregoing description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills and efforts or work conditions associated with the job. It is intended to be an accurate reflection of the general nature and level of the job.

Incumbent must have skill set to:

* Address appeals and review needed information for insurance denials to facilitate expedient resolution and reimbursement.

* Participates in mandated Medical Record Review processes.

* Interprets and applies American Hospital Association (AHA) Official Coding Guidelines to articulate and support appropriate principal, secondary diagnoses and procedures.

* Knowledge of discharge disposition and reimbursement outcomes.

* Adherence to Health Information Management (HIM) Coding policies.

* Adherence to The Joint Commission (TJC) and other third-party documentation guidelines in an effort to continually improve coding quality and accuracy.

* Responsibility for maintaining coding certification and continuing education.

* Participates in performance improvement initiatives as assigned.

The incumbent must consistently meet or exceed productivity and quality standards as defined by the HIM Coding Leadership.

Telecommuting is allowed with approval from HIM Management.

KNOWLEDGE, SKILLS & ABILITIES

1. Expert knowledge and specific details of coding conventions and use of coding nomenclature consistent with CMS' Official Guidelines for Coding and Reporting ICD-10-CM coding.
2. Expert knowledge of Anatomy and Physiology of the human body, Pharmacology, Disease Pathology, and Medical Terminology in order to understand the etiology, pathology, symptoms, signs, diagnostic studies, treatment modalities, and prognosis of diseases and procedures performed.
3. Accurate translation of written diagnostic descriptions to appropriately and accurately assign ICD-10-CM diagnostic codes and procedural codes to obtain optimal reimbursement from all payer types, including Medicare/Medicaid, private and commercial insurance payers.
4. Knowledge of clinical content standards.
5. Ability and knowledge of the appeal process to ensure accurate reimbursement.
6. Utilize critical thinking and problem-solving abilities.
7. Ability to work well with others.
8. Uphold a strong work ethic characterized by honesty and dependability.
9. Demonstrate personal time management skills, including organization, prioritization, and multitasking.
10. Adherence to company policies, procedures, and directives.

This position does not provide patient care.

The foregoing description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills and efforts or work conditions associated with the job. It is intended to be an accurate reflection of the general nature and level of the job.

Education:

Must have working-level knowledge of the English language, including reading, writing and speaking English. High School Diploma and/or GED required. Associates degree preferred.

Experience:

A minimum of 5-8 years of previous facility and/or pro-fee coding experience required. A minimum of 2 years of previous medical coding auditing experience required. Experience and knowledge in coding compliance criteria for all patient encounter types preferred.

License(s):

None

Certification(s):

CCS, CPC, and/or CPMA credentials required. (Excludes apprenticeship classification)

Computer / Typing:

Must be proficient with Microsoft Office Suite, including Outlook, Power Point, Excel, and Word. Must have the ability to use the computer to complete online learning requirements for job-specific competencies, access online forms and policies, complete online benefits enrollment, etc.