Under the direction of the Manager of Coding Audit and Education, the Coding Auditor is responsible for performing coding quality audits on a wide variety of inpatient and outpatient services. The position requires this coder to be highly proficient in the proper assignment of ICD-10-CM, PCS, CPT, HCPCS and modifier codes. Demonstrated ability to provide direction to coding staff as it relates to coding integrity, effective and compliant query application and adherence to Tenet procedures.
Provides written, detailed rationale and supporting evidence for recommendations on audit findings.
Delivers educational feedback to coding staff regarding audit findings.
Provides guidance to coding staff and management in identifying and resolving coding issues.
Collaborates with the clinical documentation improvement team for conflicts between code assignments.
Identifies documentation improvement opportunities that impact coding accuracy.
Initiates physician queries for clarification of documentation in the medical record to achieve accurate code assignment and coding integrity.
Reviews and researches billing edits.
Assists with DRG denials from payers including researching and writing appeal letters.
Ability to interpret Medicare and NCCI guidelines, National and Local Coverage Determinations to support coding compliance.
Performs other duties as assigned including training/mentoring of new staff and performing research related to special projects
Other Job Functions:
Reports results of audits to departments and committees as assigned
Identifies opportunities for intradepartmental and interdepartmental operational improvements.
Participates in coding program related meetings, physician and staff education, staff development, departmental activities and in-service opportunities.
Five years progressive coding or coding review experience in an acute care setting, including auditing
Comprehensive understanding of coding guidelines, Coding Clinics, CPT Assistant, CCI edits, and appropriate coding references along with the ability to employ these coding resources to audit findings.
Excellent interpersonal verbal and written communication skills to accurately relay information to internal and external customers.
Excellent organizational skills with ability to trend and track audit findings effectively.
Excellent problem-solving skills, the ability to work independently, and to perform under pressure in a teamwork manner with diplomacy and tact.
Proficient computer and technical skills, along with experience using MS Word, Excel and PowerPoint.
American Health Information Management Association (AHIMA) certification required such as RHIA, RHIT or CCS
An associate s degree or higher in a health-related discipline
Employment practices will not be influenced or affected by an applicant’s or employee’s race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship.