Inpatient Coding Auditor

• Knows, understands, incorporates, and demonstrates Huron’s Vision, and Values in behaviors, practices, and decisions.  

• Inpatient Coding Auditor

• Responsible for the auditing of inpatient coders and/or inpatient “audit the auditors” to ensure coding accuracy and DRG accuracy of a minimum of 95% is met. 

• Perform quality checks/audits on visits coded as per client SOPs. 

• Perform calibration audits.

• Suggest improvements and schedule calibration sessions with offshore team counterparts and leaders. 

• May assist in preparing audit reports, share direct feedback to coders and auditors on areas of opportunity, participate in client interactions and internal stakeholder meetings. 

• Firm understanding of the clinical documentation guidelines.  

• Monitor compliance of coding guidelines and ensure errors are identified during audits are corrected as appropriate, and corrective action is initiated before the claim is rebilled to the insurance. 

• Conduct analysis and present summary of findings to leadership in a clear, concise, convincing, and actionable format. 

• Utilizes encoder software applications, which includes all applicable online tools and references in the assignment of International Classification of Diseases, Clinical Modification (ICD-CM) diagnosis and procedure codes (ICD-PCS), MS-DRG, APR DRG, POA, SOI & ROM assignments.

• Ensures capture/reporting of appropriate code(s) by utilizing coding guidelines established by:

• The Centers for Disease Control (CDC), ICD-CM Official Coding Guidelines for Coding and Reporting, Centers for Medicare/Medicaid Services (CMS) ICD-PCS Official Guidelines for Coding and Reporting

• American Hospital Association (AHA) Coding Clinic for International Classification of Diseases, Clinical Modification

• American Health Information Management Association (AHIMA) Standards of Ethical Coding

• Client coding procedures and guidelines  

• Navigates the patient health record and other computer systems/sources to accurately determine diagnosis and procedures codes, MS-DRGs, APR DRGs, and identify HACs and PSIs or other indicators that could impact quality data and hospital reimbursement.

• Reviews inpatient health record documentation to assess the presence of clinical evidence/indicators to support diagnosis codes and MS-DRG, APR DRG assignments to potentially decrease denials. 

• Maintains a high degree of professional and ethical standards.

• Focuses on updating coding skills, knowledge, and accuracy by participating in coding team meetings and educational conferences.

• Maintains CEUs as appropriate for coding credentials as required by credentialing associations. 

• Maintains current knowledge of changes in inpatient reimbursement guidelines and regulations as well as new applications or settings for inpatient coding e.g., Hospital at Home. 

• Ensure patient information is correct and appropriate signatures are on all medical records.

• Demonstrates knowledge of current, compliant coder query practices when consulting with physicians, Clinical Documentation Specialists (CDS) or other healthcare providers when additional information is needed for coding and/or to clarify conflicting or ambiguous documentation. 

• Maintains a working knowledge of applicable coding and reimbursement Federal, State and local laws and regulations, Code of Ethics, as well as other policies and procedures to ensure adherence in a manner that reflects honest, ethical and professional behavior.

• Perform other duties as assigned.

CORE QUALIFICATIONS: 

• Current permanent United States Work Authorization required

• Working in the United States Day shift schedule required

• 2+ years previous experience as an inpatient coding auditor  

• 3+ years previous experience in coding inpatient hospital accounts

• Advanced proficiency with Microsoft office suite (Excel, Word, PowerPoint, Outlook, Visio, SharePoint)

• Analytical skills (problem solving, quantitative, workflow process, etc.)

• Ability to pay close attention to details; strong follow-up and follow-through skills

• Excellent time management skills; organized; ability to prioritize completing multiple tasks on schedule in a deadline driven environment

• Requires the use of independent judgement, discretion and decision-making abilities

• Ability to interact with internal and external customers in a professional manner

• Ability to ramp up on a client’s environment, processes, historical context, and systems to provide support to an engagement as soon as possible

• Financial acumen and analytical skills are required

• Experience working with data from various sources preferred 

• Familiarity with revenue cycle systems, deep understanding of revenue cycle process flow and financial analysis 

• Desire to work as part of a team in a partnership role

• Strong oral and written communication skills, analytical skills, ability to work independently, and be self-motivated are required

• Flexible and adaptable to changes

PHYSICAL DEMANDS: 

• This role requires remaining seated at a desk/computer for 8 hours daily; repetitive use of computer keyboard and mouse; use of computer monitors for 8 hours daily; interaction though video/audio conference calls and possible use of a headset with microphone; very rarely duties might require the ability to lift up to 20 pounds and bending & standing for periods at a time.

TECHNICAL QUALIFICATIONS:

• Required Certifications: 

• Certified Coding Specialist (CCS) or Certified Inpatient Coder (CIC) or Certified Documentation Improvement Practitioner (CDIP)

• Preferred Certifications: 

• AHIMA microcredentials: “Auditing:  Inpatient Coding (AIC)” 

• Regishttp://expense.huronconsultinggroup.com/tered Health Information Administrator (RHIA) preferred

• Encoder experience (3M/Solventum, Encoder Pro, Codify) preferred

• Epic experience preferred

• Cerner experience preferred

• Meditech experience preferred

• Key Performance Indicators (KPIs) - Expectations

• Coding Auditing Productivity