Coding Audit Coordinator

The Corp Coding Audit Coord reviews documentation and coding of hospital records to patients to ensure compliance with federal and state laws and regulations. Also performs audits of coding quality and maintains spreadsheets for coding area statistics and process flow.

• Medical Coding Review
• Assist in the development, performance and maintenance of a long‑term comprehensive clinical coding audit program for inpatient and outpatient coding. Conduct coding compliance and charge‑based audits, inpatient and outpatient coding reviews.
• Perform quarterly complex coding quality audits on each coder. Review 100% of coding performed by new staff until preset quality standards are met. Audit clinics with autocoding feature for accuracy of documentation and correct diagnosis assignment.
• Design and implement additional coding and billing audits on items of focus and vulnerability based on RACs, OIG workplan, public profile sites and other high‑risk areas.
• Prepare reports based on audit results, analyze coding data to identify variations, present findings to corporate coding leadership and provide input to the coding manager on yearly coder evaluations.
• Assist FMOLHS in reviews related to internal or external investigations.
• Perform code‑based charge audits to assure compliant claims data and monitor adherence to government and third‑party billing requirements to optimize revenue generation. Research and appeal payment denials received from payers within designated timelines. Analyze patterns in NCCI edits and assist FMOLHS facilities in process improvement initiatives to prevent claim failures.
• Work with the compliance officer to ensure FMOLHS entities comply with coding/billing laws and guidelines.
• Identify opportunities for documentation improvement and/or process changes.
• Collaborate with the coding manager and coding educator to identify educational opportunities from quarterly audit results. Assist the coding educator in developing education specific to issues/opportunities identified during auditing/monitoring of coding.
• Identify any medical staff training needed from issues/opportunities found during audits, notify the coding manager and coding educator of educational needs. Assist in providing training to coders, hospital staff and physicians for ICD‑10‑CM/PCS future implementation.
• Assist in compiling information as needed for various Medical Staff, Medical Records and Quality meetings.
• Serve as a resource to Internal Audit staff/RMD on coding and charge master‑related issues.
• Perform other duties as assigned or requested.
• Stay abreast of the latest developments, advancements, and trends in the field of coding by attending educational programs, reading professional journals, actively participating in professional organizations, and maintaining certification. Integrate knowledge gained into current work practices.

• 5 years of inpatient and outpatient coding experience
• Bachelor’s degree with RHIA and CCS;
  Associate’s degree with RHIT and CCS (if not current CCS, position contingent on CCS within 3 months of hire)
• Extensive knowledge of coding, including proficiency in inpatient, outpatient, ambulatory surgery and ER visits using ICD‑10‑CM/PCS, CPT coding, assignment of DRGs, APCs and official coding guidelines