Facility Inpatient Surgical and Claims Edit Auditor

Job Description The Coding Auditor works under the general direction of the Coding Supervisor and is responsible for reviewing encounters in either a pre-bill or retrospective workflow to validate coding profiles. The role includes verifying applicable code sets, abstracted data elements, missed query opportunities, and other related encounter data collection points. Auditors evaluate compliance with all coding guidelines, including internal policies, AHA and AMA coding references, and local, state and federal coding guidelines. Responsibilities Perform quality coding reviews or audits within established departmental productivity and accuracy standards. Assist with processing re-bills post coding audit changes and with coding corrections needed from the billing department. Provide written summary reports of findings. Coordinate and lead 1:1 or small group feedback sessions based on recommendations. Maintain open communication with internal and external partners and peer departments such as Coding Operations, Clinical Documentation Integrity (CDI), Payor Revenue Management (PRM), and Compliance Revenue Integrity (CRI). Assist peer departments with production coding of cases during staff shortages. Improve data quality for reporting and research, ensuring accurate billing and reimbursement of services rendered, which overall improves patient care quality. Provide 1:1 and small group education sessions, facilitate round table discussions, contribute content to the coding newsletter, and provide basic level trending or data review for opportunities. Evaluate codes through data reports and trend opportunities, audit to validate findings, and produce summary reports with recommendations of action plans. Perform additional activities such as data quality reports as assigned by the Coding Supervisor. Qualifications High school diploma or GED required; a degree in Health Information Management preferred. Minimum of 3 years of Coding Audit experience with auditing skills covering coding/billing accuracy of coding staff. Required certifications upon hire: CCS, CPC, RHIA, or RHIT. Facility inpatient surgical claims experience highly preferred. Benefits Benefits include health care, dental insurance, paid vacation, and a 403(b) retirement plan. Remote Eligibility Approved remote states: Arizona, California, Colorado, Florida, Georgia, Minnesota, Nevada, Oregon, Texas. #J-18808-Ljbffr Cedars-Sinai