Inpatient Coding Auditor

Job Purpose

The Inpatient Coding Auditor is an experienced auditor and certified professional coder with extensive knowledge of inpatient coding and auditing for various specialties, dedicated to ensuring the highest standards of coding accuracy and compliance. This position is critical for maintaining the integrity of coded data and the associated reimbursement. The ideal candidate will possess advanced knowledge of MS and APR grouping methodologies with exceptional attention to detail, and the ability to collaborate effectively with various internal teams to drive continuous improvement in coding practices. The performance of data analytics on coded data is required to identify trends and patterns in coding errors.

Duties And Responsibilities

• Collaborate with internal staff to enhance documentation, coding, and compliance
• Review and assess coding quality on accounts completed by Medical Coders
• Review clinical documentation to ensure it supports the codes assigned and meets necessary documentation standards
• Ensure adherence to workflows and ethical coding standards
• Utilize advanced knowledge of ICD-10-CM and ICD-10-PCS coding concepts
• Communicate review findings and recommendations to management
• Assess risk and obtain necessary statistics for coding areas
• Administer the Quality Monitoring Program to meet quality standards and targets
• Manage daily operational processes for quality, efficiency, and productivity
• Utilize data analytics to identify trends and patterns in coding errors, proactively addressing issues and improving overall coding quality
• Collaborate with workgroups to resolve customer-impacting issues
• Seek continuous improvement and development opportunities for the team
• Address complaints, questions, and queries as necessary
• Document team members’ performance and targets
• Monitor systems for optimal performance
• Stay updated on guideline changes, laws, and regulations affecting documentation and reimbursement
• Promote teamwork and service excellence within the department
• Participate in performance improvement activities
• Establish and maintain a formalized review process for compliance with contractual agreements on accuracy rates
• Recommend strategies to achieve high compliance with quality management plans
• Participate in calls/meetings to address performance and training improvements
• Assist in training sessions for new hires and provide refresher trainings as needed
• Ensure compliance with all Med-Metrix policies and procedures
• Identify high-risk areas in coding and develop strategies to mitigate these risks
• Provide feedback to management on potential problems and improvement areas
• Demonstrate exceptional attention to detail and accuracy in reviewing and analyzing medical records
• Possess strong analytical skills to identify trends, patterns, and areas for improvement in coding practices
• Use, protect and disclose patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards
• Understand and comply with Information Security and HIPAA policies and procedures at all times
• Limit viewing of PHI to the absolute minimum as necessary to perform assigned duties
  
  

• Hold AAPC and/or AHIMA certification, with CPMA being advantageous
• Minimum of 3-5 years of Coding and auditing.
• Equivalent work experience may be considered in lieu of professional credentials
• Demonstrated knowledge of HIPAA in Medical Coding
• Demonstrated knowledge and understanding of professional reference materials, such as Coding Guidelines and Coding Clinic
• Must be able to use job related software
• Ability to work in a team environment and adapt to changing responsibilities
• Self-starter capable of working independently and within a team
• Ability to prioritize work and remain calm under pressure
• Proficiency in Microsoft Office Suite
• Strong interpersonal skills, ability to communicate well at all levels of the organization
• Strong problem solving and creative skills and the ability to exercise sound judgment and make decisions based on accurate and timely analyses
• High level of integrity and dependability with a strong sense of urgency and results oriented
• Excellent written and verbal communication skills required
• Gracious and welcoming personality for customer service interaction
  

• Physical Demands: While performing the duties of this job, the employee is occasionally required to move around the work area; Sit; perform manual tasks; operate tools and other office equipment such as computer, computer peripherals and telephones; extend arms; kneel; talk and hear.
• Mental Demands: The employee must be able to follow directions, collaborate with others, and handle stress.
• Work Environment: The noise level in the work environment is usually minimal.