Coding Audit Coordinator

The Corp Coding Audit Coord reviews documentation and coding of hospital records to patients to ensure compliance with federal and state laws and regulations.  Also performs audits of coding quality and maintains spreadsheets for coding area statistics and process flow.  

1. Medical Coding Review
   1. Assist in the development, performance and maintenance of a long term comprehensive, clinical coding audit program for inpatient and outpatient coding. Conducts coding compliance and charge-based coding audits, inpatient and outpatient coding reviews.
   2. Performs quarterly complex coding quality audits on each coder. Reviews 100% of coding performed by new staff until preset quality standards are met. Audits clinics with autocoding feature for accuracy of documentation and correct diagnosis assignment.
   3. Designs and implements additional coding and billing audits on items of focus and vulnerability based on RACs, OIG workplan, public profile sites and other areas considered high-risk from a compliance standpoint.
   4. Prepares reports based on audit results (including recommendations for improvement); analyzes coding data to identify coding variations and determine cause for variation. Presents findings to Corporate Coding leadership. Provides input to coding manager on quality of coding for each coder at yearly evaluation.
   5. Assists FMOLHS in reviews related to internal or external investigations.
2. Quality/Compliance Review
   1. Performs code-based charge audits to assure compliant claims data and monitors adherence to government and third-party billing requirements to optimize revenue generation. Researches and appeals payment denials received from payers as necessary within designated timelines. Analyzes any identified patterns in NCCI edits and assists FMOLHS facilities with implementing process improvement initiatives to prevent claim failures.
   2. Works with compliance officer to ensure that FMOLHS entities comply with coding/billing laws and guidelines.
   3. Identifies opportunities for documentation improvement and/or process changes.
3. Collaboration & Partnership
   1. Collaborates with coding manager and coding educator to identify educational opportunities from results of quarterly audits. Assists coding educator in development of education specific to issues/opportunities identified during auditing/monitoring of coding.
   2. Ientifies any medical staff training needed from issues/opportunities found during audits, notifying coding manager and coding educator of educational needs. Assists in providing training to coders, hospital staff and physicians for ICD-10-CM/PCS future implementation.
   3. Assists in compiling information as needed for various Medical Staff, Medical Records and Quality meetings.
   4. Serves as a resource to Internal Audit staff/RMD on coding and chargemaster-related issues.
4. Other Duties As Assigned
   1. Performs other duties as assigned or requested.
   2. Stays abreast of the latest developments, advancements, and trends in the field of coding by attending educational programs, reading professional journals, actively participating in professional organizations, and maintaining certification. Integrates knowledge gained into current work practices.

• 5 years IP and OP coding experience
• Bachelors degree with RHIA and CCS; Associates degree with RHIT and CCS (if not current CCS, position contingent on CCS within 3 months of hire)
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• Extensive knowledge of coding to include proficiency in coding of inpatient, outpatient, ambulatory surgery and ER visits using knowledge of ICD-9 and CPT coding; assignment of DRGs, APCs and official coding guidelines.
• CCS