The Coding Quality Auditor is responsible for performing coding quality audits on inpatient and outpatient encounters to validate code assignment in compliance with Official Coding Guidelines as supported by clinical documentation in the health record. The position requires this coder to be highly proficient in the proper assignment of ICD-10-CM, PCS, CPT, HCPCS and modifier codes.
REQUIRED KNOWLEDGE AND EXPERIENCE
Ability to consistently and accurately audit coding of inpatient and outpatient encounters
Ability to create clear and concise audit reports and maintain productivity standards
Comprehensive understanding of coding guidelines, AHA Coding Clinics, CPT Assistant, CCI edits, and appropriate coding references along with the ability to employ these coding resources to audit findings.
Knowledge of MS-DRG classification and various reimbursement structures
Highly proficient computer and technical skills, along with experience using MS Word, Excel and PowerPoint.
Ability to conduct online meetings and educational sessions
Must be detail oriented and have the ability to work independently
Must display excellent interpersonal skills
Ability to demonstrate initiative and discipline in time management and assignment completion
Ability to work in a virtual setting under minimal supervision
Must successfully pass pre-hire coding assessment
MAJOR AREAS OF RESPONSIBILITY (%)
Understands, interprets and applies coding guidelines for coding audits. Audits inpatient and outpatient encounters code assignments. Reviews 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-10 CM/PCS codes, MS-DRGs, APR-DRGâ��s, CPTâ��s, APCâ��s, 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.
Assists with DRG denials from payers including researching denial rationale and drafting appeal letters.
Stays current with AHA Official Coding and Reporting Guidelines, CMS and other agency directives for ICD-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.
Five (5) years of progressive coding experience in an acute care setting, including inpatient and outpatient encounters with a minimum of at least one (1) year of coding audit experience
Associates degree in relevant field preferred or combination of equivalent education and experience
American Health Information Management Association (AHIMA) certification required such as RHIA, RHIT or CCS.
American Academy of Professional Coders (AAPC) certifications also considered
A pre-employment coding proficiency assessment will be administered.
Primary Location: Texas
Facility: 963-Santa Ana, CA
Other Locations: Alabama,California,Florida,Georgia,Massachusetts,South Carolina,Tennessee,Michigan,Arizona
Job Type: Full-time
Shift Type: Days
Employment practices will not be influenced or affected by an applicantâ��s or employeeâ��s race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship.
Internal Number: 2105014813
Tenet Healthcare Corporation (NYSE: THC) is a diversified healthcare services company headquartered in Dallas with 112,000 employees. Through an expansive care network that includes United Surgical Partners International, we operate 65 hospitals and approximately 510 other healthcare facilities, including surgical hospitals, ambulatory surgery centers, urgent care and imaging centers and other care sites and clinics. We also operate Conifer Health Solutions, which provides revenue cycle management and value-based care services to hospitals, health systems, physician practices, employers and other clients. Across the Tenet enterprise, we are united by our mission to deliver quality, compassionate care in the communities we serve.