JOB SUMMARY

Conducts coding compliance audits of inpatient and outpatient encounters to validate code assignment is in compliance with the official coding guidelines as supported by clinical documentation in health record. Validates abstracted data elements that are integral to appropriate payment methodology.

 

ESSENTIAL DUTIES AND RESPONSIBILITIES

Include the following. Others may be assigned.

Understands, interprets and applies coding guidelines for coding audits. Audits inpatient and outpatient encounters code assignments. Review of medical records to determine coding accuracy of all documented diagnoses and procedures. Reviews claims to validate submitted codes and abstracted data including but not limited to ICD-9/10 CM/PCS codes, MS-DRGs, CPT’s, APCs, and discharge disposition which all impact facility reimbursement. Creates clear and accurate audit findings and recommendations in written audit reports that will be used for advising and educating Coders, Auditors, Managers, and Directors throughout the organization. Identifies documentation issues (lacking documentation, missed physician queries, etc.) that impact coding accuracy. Clearly communicates (verbally and in written reports or summaries) opportunities for documentation improvement related to coding issues. Stays current with AHA Official Coding and Reporting Guidelines, CMS and other agency directives for ICD-9/10-CM/PCS and CPT coding. Completes online education courses and attends mandatory coding workshops and/or seminars (IPPS and OPPS, ICD-9-CM and CPT updates) for inpatient and outpatient coding. Reviews AHA and CPT quarterly coding update publications. Attends all internal conference calls for Quarterly Coding Updates.

 

EDUCATION / EXPERIENCE

Include minimum education, technical training, and/or experience preferred to perform the job.

Associates degree in relevant field preferred or combination of equivalent of education and experience Five (5) years coding experience including but not limited to hospital inpatient and outpatient encounters