Coding Compliance Auditor 2, Health Information Management, Full Time, Days

Department : Health Information Management

Address : 1611 NW 12 Ave, Miami, FL 33163

Shift Details : Monday to Friday, Days. This is a remote position and is only open to candidates in Florida.

Jackson Memorial Hospital is the flagship hospital for Jackson Health System and it has been a beacon of medical excellence and community care for more than a century. Throughout its rich and storied history, Jackson Memorial - located in the heart of the City of Miami - has been ground zero for some of the world's greatest medical breakthroughs and important moments in South Florida. We've grown into one of the nation's largest public hospitals, and one of the few that is also a world-class academic medical center with a proud mission and proven success. Jackson Memorial is an accredited, tertiary teaching hospital with 1,500 licensed beds, where nearly every medical specialty is provided by some of the world's most skilled and highly regarded multidisciplinary team of healthcare professionals.

Summary

The HIM Coding / Compliance Auditor 2 analyzes abstracted, coded data for the purpose of ensuring coding accuracy. Serves as a resource for expert knowledge in coding and documentation requirements. Performs coding audits on inpatient and outpatients coders, reviews SMART edits, external coding audits, claim denials and audits from insurance companies, as well as, any other coding audits. Works very closely with the CDI Department. Must be an expert on ICD-9 and CPT Coding systems. Must have ICD-10 knowledge.

Responsibilities

• Performs Internal Coding Audits on inpatient and outpatient coders providing feedback and re-training as required.
• Reviews findings from External Coding Audits for validity of DRG assignment and provide responses if there is a disagreement.
• Discusses findings and any discrepancies in coding accuracy with external vendor, citing Coding Guidelines and coding Clinics.
• Perform SMART edit reviews and educate the internal coders on their errors.
• Review and respond to email requests from the CBO for DRG validation, missing procedure codes, Discharge Status discrepancies and Present on Admission assignments.
• Provide responses to inquires from insurance companies regarding accuracy in codes used by the facility.
• Reviews claim denials / audits from insurance companies.
• Provide education and guidance to the CDI team and the inpatient and outpatient coding staff, reviewing diagnoses and / or procedures that require clarifications.
• Annual coding updates are reviewed at these sessions, as well as, Coding Guidelines and Coding Clinics.
• Works with the Rehabilitation Teams from Jackson Main and Jackson North reviewing and advising on concurrent coding worksheets.
• Works with the CBO and the Revenue Cycle Team providing DRG validation and correcting accounts with missing or incorrect coding.
• Provides feedback to the coder involved in each case.
• entering coding for in-house patients as per CBO request.
• Works closely with the CDI Team including concurrent DRG validation; provides assistance with assigning DRG's to in-house patients and provides individual guidance and education in applying Coding Guidelines.
• Works with different services educating them on appropriate documentation to support the severity of the patient's condition. Neonatology Team, Burn Center, etc

Experience

Education

Jackson Health System is an equal opportunity employer and makes employment decisions without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, disability status, age, or any other status protected by law.