Inpatient Coding Auditor

Our Promise to You Joining AdventHealth is about being part of something bigger. It’s about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better. Benefits Benefits from Day One: Medical, Dental, Vision Insurance, Life Insurance, Disability Insurance Paid Time Off from Day One 403-B Retirement Plan 4 Weeks 100% Paid Parental Leave Career Development Whole Person Well-being Resources Mental Health Resources and Support Pet Benefits Schedule: Full time Shift: Day (United States of America) Address: 3100 E FLETCHER AVE City: TAMPA State: Florida Postal Code: 33613 Job Description Performs quality reviews on coded records to validate ICD-10, ICD-10-PCS, MS-DRG, APR-DRGs, and overall coding accuracy retrospectively and concurrently. Provides continuing education to individual coders and the coding staff concerning changes in the coding and reimbursement system and any weaknesses identified during the coding validation reviews. Reviews, analyzes, and interprets clinical documentation, seeking clarification from the physician when discrepancies exist, and effectively communicates with physicians and allied health personnel. Assists with writing compelling appeals to all DRG denials from outside agencies, referencing Official Coding Guidelines and Coding Clinic advice as appropriate to defend the DRG assignment and protect the organization’s reimbursement. Serves as a resource to other departments in the Revenue Cycle to ensure business continuity and optimal revenue cycle management. Uses critical thinking and sound judgment in decision-making, balancing reimbursement considerations with regulatory compliance. Prepares statistical reports conveying the individual and overall accuracy of coding. Assumes personal responsibility for professional growth, development, and continuing education to maintain a high level of proficiency. Maintains the confidentiality of employees, patients, administrative, and medical staff information with no infractions. Works with other Coding team members to keep coding within two days of discharge and hospital coding days within three days, maintaining a median coding turn-around time of 3 days or less. Meets and maintains established productivity standards and a 98% or better in coding accuracy. Performs concurrent coding as assigned. Other duties as assigned. Experience with Optum CAC and Optum Audit and Compliance Manager (Auditing Tool) Comprehensive experience with cases requiring more complex coding skills, such as advanced cardiovascular, cardiothoracic, neurological, and orthopedic surgical procedures, extended or prolonged length of stays (> 100 days), BMT and other solid organ transplantations, ECMO, cutting-edge surgical advancements that are considered new and innovative, procedures that may be considered experimental or research-based, and other complicated treatments or procedures provided in a quaternary care facility. [Preferred] Knowledge, Skills, and Abilities Expansive knowledge of Medicare DRGs, APR-DRG, coding guidelines and guidance materials, and reimbursement systems. [Required] Excellent interpersonal, verbal, and written communication skills; proficient in and demonstrate excellent physician relations. [Required] Computer skills, including Microsoft Office and Encoder software. [Required] Self-motivated and able to work independently in a remote setting. [Required] Critical thinking and problem-solving skills [Required] Comprehensive knowledge of coding functions, rules, and guidelines related to DRG assignments. [Required] Strong ability to organize/triage work and manage multiple priorities simultaneously with little supervision. [Required] Possesses knowledge about risk adjustment and publicly reported hospital data. [Required] Possesses knowledge about patient safety indicators, SOI/ROM, and the importance of hospital publicly reported data, value-based purchasing, and how coding impacts these measures. [Required] Exhaustive knowledge of inpatient coding and working knowledge of ICD-10-CM, ICD-10-PCS, MSDRG’s, APRDRG’s, HAC’s, POA indicators, CMI and all regulatory compliance requirements. [Required] Excellent computer skills with a knowledge of Excel spreadsheets. [Required] Education High School Grad or Equiv [Required] Technical/Vocational School [Preferred] Field of Study in a related field of study or equivalent technical experience Work Experience 5+ years of inpatient or outpatient coding or auditing experience [Required] Additional Information N/A Licenses and Certifications Registered Health Information Administrator (RHIA) [Required] Registered Health Information Technician (RHIT) [Required] Certified Coding Specialist (CCS) [Required] Certified Professional Coder (CPC) [Required] Physical Requirements Physical Requirements - Pay Range $26.29 - $48.91 This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances. #J-18808-Ljbffr