Talent.com
Medical Coding Auditor

Medical Coding Auditor

Exceptional Healthcare Inc.Dallas, TX, US
30+ days ago
Job type
  • Full-time
  • Quick Apply
Job description

Job Summary :

  • Conducts data quality audits of inpatient admissions and outpatient encounters to validate coding assignment complies with the official coding guidelines as supported by clinical documentation in health records.
  • Validates abstracted data elements that are integral to appropriate payment methodology.

Responsible for effectively communicating information and audit findings through presentations, graphs, reports, and educational materials, etc.   Job Responsibilities / Duties :

  • Chart Analysis IP, OP Coding Data auditing and validation : Reviews medical records for the determination of accurate assignment of all documented diagnoses and procedures.
  • Adheres to Standards of Ethical Coding (AHIMA).
  • Reviews medical records for the determination of accurate assignment of all documented diagnoses and procedures.
  • Reviews claim to validate abstracted data including but limited to discharge disposition which impacts facility reimbursement and / or MS-DRG assignment.
  • Adheres to Standards of Ethical Coding (AHIMA).

    • Reviews medical records to determine accurate required abstracting elements (facility / client / payer-specific elements) including appropriate discharge disposition

  • IP, OP Coding :
  • Reviews medical records for the determination of accurate assignment of all documented ICD-10-CM codes for diagnoses and procedures.

    • Abstracts accurate required data elements (facility / client specific elements) including appropriate discharge disposition.

  • Coding :
  • Uses discretion and specialized coding training and experience to accurately assign ICD-10, CPT-4 codes to patient medical records.
  • Abstracting : Reviews medical records to determine accurate required abstracting elements (client specific elements) including appropriate discharge disposition.
  • Coding Quality : Demonstrates ability to achieve accuracy and consistency in the selection of principal and secondary diagnoses (including MCC & CC) and procedures.

    • Demonstrates ability to achieve accuracy and consistency in abstracting elements defined by SOW.

  • Professional Development :
  • Stays current with AHA Official Coding and Reporting Guidelines, CMS and other agency directives for ICD-10-CM and CPT coding.
  • Attends mandatory coding seminars on an annual basis (IPPS and OPPS, ICD-10-CM, and CPT updates) for inpatient and outpatient coding.
  • Quarterly review of AHA Coding Clinic.

    • Attends Quarterly Coding Updates and all coding conference calls

  • Create audit schedules and manage workflows to adhere to the audit schedule.
  • Develop methods to effectively communicate information through presentations, graphs, reports, educational materials, etc.
  • Develop, establish, and review policies and objectives consistent with those of the organization to ensure efficient departmental operations.
  • Performs charge audits by comparing itemized bills to medical record documentation to ensure appropriate charging.
  • Review, assess, study, and analyze the overall coding, billing, documentation, and reimbursement system for potential compliance problems.
  • Performs all other duties as assigned.   Qualifications & Experience :
  • Ability to consistently code at 95% accuracy and quality while maintaining client-specified production standards
  • Must successfully pass a coding test
  • Knowledge of medical terminology, ICD-9-CM and CPT-4 codes
  • Must be detail-oriented and can work independently
  • Computer knowledge of MS Office
  • Must display excellent interpersonal skills
  • The coder should demonstrate initiative and discipline in time management and assignment completion
  • The coder must be able to work in a virtual setting under minimal supervision
  • Intermediate knowledge of disease pathophysiology and drug utilization
  • Intermediate knowledge of MS-DRG classification and reimbursement structures
  • Intermediate knowledge of APC, OCE, NCCI classification and reimbursement structures   EDUCATION / EXPERIENCE
  • Associate degree in a relevant field preferred or a combination of the equivalent of education and experience
  • Three years of coding experience including hospital and consulting background CERTIFICATES, LICENSES, REGISTRATIONS
  • AHIMA Credentials, and or AAPC
  • Certified Professional Medical Auditor by AAPC PHYSICAL DEMANDS
  • Requires visual acuity to inspect and analyze work close to the eyes and ability to hear sound with or without correction; Ability to climb, stoop, kneel, reach, stand, walk pull, push lift, and able to exert up to 40 pounds of force occasionally and / or up to 10 pounds of force constantly to move objects.
  • Moderate physical activity performing somewhat strenuous daily activities of a primarily administrative nature.
  • The physical demands for this position include adequate vision, hearing, and repetitive motion.
  • Ascending or descending stairs, ramps, and the like, using feet and legs and / or hands and arms.
  • Substantial movements (motion) of the wrist, hands, and / or fingers in a repetitive manner - Bending legs downward and forward by bending leg and spine - Standing, particularly for sustained periods of time.

    • Using upper extremities to exert force to draw, drag, haul or tug objects in a sustained motion.

  • Raising objects from a lower to a higher position or moving object horizontally from position to position WORK CONDITIONS
  • While performing the duties of this job, the employee is frequently required to stand, walk, sit, reach with hands and arms, and talk or hear.
  • The employee is occasionally required to stoop, kneel, crouch, or crawl and taste or smell.
  • The employee is required to have close visual acuity to perform an activity such as :
  • preparing and analyzing data and figures, transcribing, and viewing a computer terminal.
  • Powered by JazzHR
    • Create a job alert for this search

    Medical Coding Auditor • Dallas, TX, US