Outpatient Coding Compliance Auditor - FT - Days - Remote Eligible

Coding Auditor

Location: Miramar, Florida

At Memorial, we are dedicated to improving the health, well-being and, most of all, quality of life for the people entrusted to our care. An unwavering commitment to our service vision is what makes the difference. It is the foundation of The Memorial Experience.

Job Description

Responsible for auditing coded inpatient or outpatient medical records applying ICD-10 CM/PCS and/or CPT-4. Reviews Ambulatory Payment Classification (APC), Medicare Severity Diagnosis Related Groups (MSDRG) and All Patients Refined Diagnosis Related Groups (APRDRG) assignment and queries following official coding guidelines and regulatory requirements. Provides training and education based on audit results and any regulatory changes that effect Federal, State and American Health Information Management Association (AHIMA) guidelines.

Responsibilities

Maintains strict adherence to patient confidentiality according to MHS standards and regulatory requirements. Works closely with inpatient and outpatient coding managers to analyze and resolve claim denials that are rejected by edits from the Revenue Cycle Department. Reviews and responds to all external coding denial audits using ICD-10CM/PCS, CPT and APC, MSDRG, and APRDRG audits. Conducts and reports on electronic medical record audits to verify ICD-10CM/PCS, CPT and APC, MSDRG, and APRDRG coding and grouping accuracy. Serves as an expert resource for all coding staff. Assists with developing specific departmental goals, standards, and objectives which directly support the strategic plan and vision of the organization. Maintains thorough knowledge of ICD-10CM/PCS, and CPT coding principles and guidelines; possesses substantial knowledge of MSDRG, APRDRG, APC, and Enhanced Ambulatory Patient Groups (EAPG) classification systems and query guidelines for compliant provider documentation. Coordinates, develops, and implements coder intern education and training. Training will align with AHIMA standards of ethical coding and official coding guidelines. Provides feedback based on audit results and tracks coder intern progression throughout the program. Holds educational sessions for coding specialists, documentation specialists, and physicians. Acts as a liaison for electronic physician query process. Utilizes coding audit results to tailor education to increase coding accuracy. Assists the coding staff to format compliant queries and assesses for compliance with AHIMA query standards. Reports results of coding and query compliance audits to management. Performs all other duties as assigned.

Competencies

ACCOUNTABILITY, ACCURACY, CUSTOMER SERVICE, EFFECTIVE COMMUNICATION, HUMAN ANATOMY, MEDICAL CODING, MEDICAL TERMINOLOGY (3), RESPONDING TO CHANGE, STANDARDS OF BEHAVIOR

Education and Certification Requirements

Accredited Program: Health Information Management (Required)Certified Coding Specialist (CCS) - American Health Information Management Association (AHIMA), Registered Health Information Administrator (RHIA) - American Health Information Management Association (AHIMA), Registered Health Information Technician (RHIT) - State of Florida (FL)

Working Conditions and Physical Requirements

• Bending and Stooping = 40%
• Keyboard Entry = 60%
• Kneeling = 40%
• Lifting or Carrying 0 - 25 lbs Non-Patient = 40%
• Pushing or Pulling 0 - 25 lbs Non-Patient = 40%
• Reaching = 40%
• Repetitive Movement Hand/Arm = 60%
• Sitting = 60%
• Squatting = 20%
• Standing = 60%
• Walking = 60%
• Audible Speech = 60%
• Hearing Acuity = 60%
• Depth Perception = 60%
• Distinguish Color = 60%
• Seeing - Far = 60%
• Seeing - Near = 60%
• Potential Electric Shock = 60%