Coding Auditor - Outpatient

Overview

The coding auditor is responsible for ensuring the integrity of inpatient and/or outpatient medical records by auditing them to confirm that clinical documentation accurately supports the diagnosis, CPT and/or DRG assigned. This position requires a detailed understanding of medical coding principles, coding guidelines, coding clinics, CPT Assistant and the ability to perform objective medical audits. The auditor will conduct audits drawing on advanced ICD-10 and CPT coding expertise, and coding guidelines to substantiate their recommendations.

In this role, the auditor will review accounts flagged by Streamline, eValuator and provide recommendations if determined necessary. The auditor will also be responsible for identifying potential trends and educational opportunities.

The coding auditor will also conduct focus reviews as determined by the coding manager. The auditor must be task oriented and have strong ability to work independently on assigned tasks. The auditor will work in conjunction with physician advisors, HIMS leadership and other appropriate staff to coordinate and perform internal audits and make recommendations to ensure compliance with Federal and State regulations and OIG compliance guidelines.

Assist with training of new staff members, coding and other duties as assigned by Leadership.

• Analyze patient records, including physician documentation, operative reports and other relevant data to verify the accuracy of assigned codes.
• Proficiency in DRG assignments, ICD-10 CM, ICD-10-PCS, CPT, official coding guidelines, medical terminology, human anatomy and physiology, pathophysiology, pharmacology, and proficiency in Microsoft Office products (Word and Excel).
• Excellent verbal and written communication skills.
• Writes clear, accurate and concise recommendations in support of findings while providing feedback and education to the coders, referencing current ICD-10-CM/PCS, Official Coding Guidelines, CPT guidelines and AHA Coding Clinics.
• Ability to work independently and exercise independent judgment.
• Critical thinking skills.
• Research coding questions asked by coding and other areas in a timely manner.
• Must have knowledge of the Clinical Documentation Management Program and assist the Documentation Specialist with questions regarding code/DRG assignment.
• Serves as back up for the Coding Specialist II and Coding Specialist III teams when needed.
• Make recommendations on coding education and training based on audit results.
• Other duties and responsibilities, as assigned.
• Maintains AHIMA credentials, CEU's and up to date knowledge of coding guidelines.

• Associate or Bachelor s degree in AHIMA accredited Health Information Management program with credentialing as a RHIA or RHIT.
• An AHIMA certified Coding Specialist (CCS) credential may be substituted in lieu of a degree.
• 5 years or more experience inpatient coding experience.

• Remote role (based out of Greenville, NC)
• Monday - Friday day shift
• Great Benefits

ECU Health is a mission-driven, 1,708-bed academic health care system serving more than 1.4 million people in 29 eastern North Carolina counties. The not-for-profit system is comprised of 13,000 team members, nine hospitals and a physician group that encompasses over 1,100 academic and community providers practicing in over 180 primary and specialty clinics located in more than 130 locations. The flagship ECU Health Medical Center, a Level I Trauma Center, and ECU Health Maynard Childrens Hospital serve as the primary teaching hospitals for the Brody School of Medicine at East Carolina University.

ECU Health and the Brody School of Medicine share a combined academic mission to improve the health and well-being of eastern North Carolina through patient care, education and research.

It is the goal of ECU Health and its entities to employ the most qualified individual who best matches the requirements for the vacant position.

Offers of employment are subject to successful completion of all pre-employment screenings, which may include an occupational health screening, criminal record check, education, reference, and licensure verification.

We value diversity and are proud to be an equal opportunity employer. Decisions of employment are made based on business needs, job requirements and applicants qualifications without regard to race, color, religion, gender, national origin, disability status, protected veteran status, genetic information and testing, family and medical leave, sexual orientation, gender identity or expression or any other status protected by law.

We prohibit retaliation against individuals who bring forth any complaint, orally or in writing, to the employer, or against any individuals who assist or participate in the investigation of any complaint.