Auditor/Educator In/Outpatient

Essential Job Functions: 

Initial Audit and Education:

• For assigned coding staff, conduct initial quality audits as they go through onboarding process for new project / client assignment, and provide education to staff based on initial quality audit findings. Review medical records for accuracy of coding and data quality. Elements included in reviews may include:

  CDI audit reviews

• Auditing:
  
  
  
  • Reviewing medical records, including clinical notes, lab results, and other diagnostic information, to ensure documentation accurately reflects diagnoses, severity of illness, and risk of mortality. 
  
  


• Compliance:
  
  
  
  • Ensuring documentation complies with regulatory requirements, coding guidelines, and payer rules. 
  
  


• Identifying Gaps:
  
  
  
  • Identifying missed documentation opportunities, inconsistencies, and areas where documentation can be more specific or clarified. 
  
  


• Query Review:
  
  
  
  • Evaluating the appropriateness of queries issued to physicians, ensuring they are supported by clinical evidence and aligned with coding guidelines. 
  
  


• Data Analysis:
  
  
  
  • Analyzing data related to CDI performance, identifying trends, and reporting findings to leadership. 
  
  


• Education and Training:
  
  
  
  • Providing education and training to CDI staff, physicians, and other healthcare professionals on documentation best practices, coding guidelines, and regulatory requirements.
  
  


• Skills and Qualifications:


• Clinical Knowledge:
  
  
  
  • Strong understanding of disease processes, clinical conditions, and medical terminology. 
  
  


• Coding Knowledge:
  
  
  
  • Familiarity with ICD-10-CM/PCS, CPT, and other relevant coding systems. 
  
  


• CDI Experience:
  
  
  
  • Experience in clinical documentation integrity, including chart review and query writing. 
  
  


• Analytical Skills:
  
  
  
  • Ability to analyze data, identify trends, and make recommendations for improvement. 
  
  


• Communication Skills:
  
  
  
  • Excellent written and verbal communication skills to effectively communicate with various healthcare professionals.
  
  

•    Inpatient /Observation Cases

• All diagnosis and procedure assigned ICD-10-CM and ICD-10 PCS codes


• Discharge disposition assigned


• Assigned Present on Admission (POA) indicators


• APR-DRG, MS-DRG, SOI, and ROM assignment for inpatient cases


• Appropriateness of queries created

  Outpatient Cases (ER, SDS, Ancillary)

• All diagnosis and procedure assigned ICD-10-CM and ICD-10 PCS codes


• All CPT assigned codes


• Modifier use and assignment


• APC assignment

Employee must be fluent in auditing facility inpatient, Outpatient is a plus. Will be trained in DRG appeal writing. Must be experienced in Word and Excel. CDI credential is a plus.