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Job Description
The Coding Quality Auditor is responsible for assessing coding accuracy and completeness of inpatient and outpatient medical record documentation by conducting random and focused coding audits; documenting, preparation and presentation of audit results; including investigations and presentation of feedback. Acts a coding expert resource Responsibilities:* + Responsible for auditing Electronic Medical Records and/or, procedural cases and/or surgical cases, pre-bill coding, DRG and APC Quality Audits, case mix analysis, and compliance software reviews on highly complex cases.
+ Responsible for providing feedback on the application of coding guidelines, practices, and proper documentation techniques, data quality improvements, and revenue enhancements. + Performs retrospective and concurrent audits based on coding guidelines to ensure coding accuracy and proper reporting. + Prepares and presents reports for pre-bill and retrospective coding audits directly to audited Providers and coders.
+ Demonstrates the ability to analyze coded data to identify areas of risk and provide suggestions for documentation improvement. + Assists in the development of programs and procedures to support improvement of coding accuracy rate. + Interacts with Providers, and coding staff to resolve documentation or coding issues.
+ Responds to coding questions from assigned coders/providers and provides official coding references and guidelines. + Provides routine interaction with Providers, and coding staff to assist with or resolve issues relating to medical record documentation and coding. + Assists with the facilitation of scheduled external audits.
+ Assists with the analysis of case mix reports and other statistical reports. + Maintains current knowledge of coding principles and guidelines as coding conventions are updated; monitors and analyzes current industry trends and issues for potential organizational impact. + Reports any compliance and/or risk issues to the compliance department.
Provides suggestions on process improvement. + Makes recommendations for coding policy/guideline changes. + Other duties as assigned Education* : + High School Diploma required.
+ Associate’s Degree preferred. + A Bachelor’s Degree preferred. + Specific training related to CPT procedural coding and ICD-10 diagnostic coding through continuing education programs/seminars and/or community college preferred Certifications* : + A minimum of one of the following certifications is required and must be maintained: the American Health Information Management Association (AHIMA) Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Coding Specialist (CCS), Certified Coding Specialist-Physician (CCS-P), or the American Academy of Professional Coders (AAPC) Certified Inpatient Coder (CIC) or Certified Professional Coder (CPC) Complexity of Work* : + Coding assessment relevant to the work may be required.
+ Ability to present information to various audiences. + Proficiency in Microsoft Office Applications (eg, Word, Excel). + In depth knowledge of ICD-10-CM/PCS coding principles, CPT coding principles, DRG assignment, APC assignment, and modifier assignment.
+ Working knowledge of human anatomy and physiology, disease processes. + Demonstrated knowledge of medical terminology. + Knowledge of auditing concepts and principles.
+ Excellent verbal and written communications Work Experience* : + A minimum of 5 years professional coding experience required. + A minimum of 2 years of progressive on-the-job experience as a coding quality auditor in a health care environment and/or medical office setting preferred. + An Associate’s Degree may offset up to 1 years of required experience.
+ A Bachelor’s Degree may offset up to 2 years of required experience Physical Requirements* : + Ability to perform work in a stationary position for extended periods. + Ability to travel throughout the hospital system. + Ability to work with physical records, such as retrieving and filing them.
+ Ability to operate a computer and other office equipment. + Ability to communicate and exchange accurate information. + In some locations, ability to move up to 25 lbs Personal Protective Equipment:* + Follows standard precautions using personal protective equipment as required.
Cleveland Clinic Health System is pleased to be an equal employment employer: Women/Minorities/Veterans/Individuals with Disabilities.
