In an environment of continuous quality improvement, the Coding Auditor will assist in the review of medical records documentation to ensure completeness, accuracy, and compliance with applicable federal and state regulations and guidelines. The Coding Auditor will also be responsible for all documentation and coding education that is provided to the coding staff and providers. Exhibits the Standards of Excellence and exercises strict confidentiality at all times.
Job Functions:
- Manages quality improvement audits and training of designated coding staff and providers.
- Researches, analyzes, and responds to internal and external inquiries regarding compliance, inappropriate coding, denials, and billable services.
- Acts as expert coding resource to coders, clinical documentation improvement, providers, and other departments within the hospital or provider clinics.
- Provides technical support regarding coding compliance documentation; electronic medical records, regulatory provisions, and third party payer requirements.
- Develops and maintains coding related policies, procedures, query development, and training materials in conjunction with management.
- Organizes, facilitates, performs, tracks, trends, and reports on internal quality reviews.
- Ensures audit (external and internal) recommendations are completed (ie education, coding changes, or rebills)
- Ensures strict confidentiality of financial records.
- Communicates with the coding management are denial trends, coding or documentation issues, and any pending audits or education.
- Remain informed about coding issues to comply with federal regulations and updates the coding team.
Minimum Education/Experience Required:
- High School Diploma/GED required.
- Bachelor’s degree in Health Information Management or related field preferred.
- Coding certification (i.e. CCS, CPC, COC, CIC, RHIT, RHIA) with 4 years coding experience required.
- Previous supervisory or management experience preferred.
Special Knowledge, Skills, Training:
- Knowledge of coding guidelines; CPT, ICD-10-CM, ICD-10-PCS, MS-DRG, HCC, APR-DRG and HCPCS assignment.
- CCI edits, LMRP, federal and state compliance and/or regulatory guidelines.
- Reimbursement methodologies and healthcare information systems.
- Computer knowledge (Windows Based), including word processing and spreadsheets.
- Must be able to communicate written and orally with professional and technical staff.
- Must also possess organizational and time management skills.
- Must also be able to train and mentor others.
Compensation Details: Education, experience, and tenure may be considered along with internal equity when job offers are extended.
Benefits: Memorial Health System is proud to offer an affordable, comprehensive benefit package to all full time and flex time employees. To learn more about the many benefits we offer, please visit our website at www.mhsystem.org/benefits.
Bonus Eligibility: Available to qualifying full or flex time employees. Eligibility will be determined upon offer.
Memorial Health System is an equal opportunity provider and employer.
If you wish to file a Civil Rights program complaint of discrimination, complete the USDA Program Discrimination Complaint Form, found online at https://www.ocio.usda.gov/document/ad-3027, or at any USDA office, or call (866) 632-9992 to request the form. You may also write a letter containing all of the information requested in the form. Send your completed complaint form or letter to us by mail at U.S. Department of Agriculture, Office of the Assistant Secretary for Civil Rights, 1400 Independence Avenue, S.W., Stop 9410, Washington, D.C. 20250-9410, by fax (202) 690-7442 or email at [email protected].
* Memorial Health System is a federal drug-free workplace. This policy prohibits marijuana use by employees.
Skills Required
- High school diploma or GED
- Bachelor's degree in Health Information Management or a related field
- Coding certification such as CCS, CPC, COC, CIC, RHIT, or RHIA
- Four years of coding experience
- Previous supervisory or management experience
- Knowledge of coding guidelines, CPT, ICD-10-CM, ICD-10-PCS, MS-DRG, HCC, APR-DRG, and HCPCS assignment
- Knowledge of CCI edits, LMRP, and federal and state compliance or regulatory guidelines
- Knowledge of reimbursement methodologies and healthcare information systems
- Computer skills, including Windows, word processing, and spreadsheets
- Written and oral communication skills with professional and technical staff
- Organizational and time management skills
- Ability to train and mentor others
What We Do
At Memorial Health, we care for people, not just conditions. Whether you’re looking for a trusted primary care provider or facing something unexpected, we are here for you every step of the way.
