Professional Coding Auditor

About the position

Evaluates prebill hospital inpatient coding compliance edits to ensure compliance with payer reimbursement methodologies and official coding guidelines. Summarizes quality review results for Coding Managers, Supervisors, Coding Educator, and coding staff; Participates in team meetings with coding personnel when necessary to discuss coding findings. Reviews, researches, and responds to coding inquiries from other Franciscan departments. Serves as the subject matter expert with regards to diagnosis and procedure codes, coding guidelines, medical terminology, anatomy/physiology, reimbursement schemes, payer specific guidelines, public reporting of outcomes, quality of patient care outcome measures, and the interpretation of coded data as it relates to revenue cycle compliance. Provides details specific to audit trends to the Coding Educator for preparation of ongoing education. Notifies coding leadership of trends and topics for education and feedback to coders, physicians, and departments. Assists with identification and implementation of process improvements according to industry best practice standards to make the best use of resources, decrease costs and improve coding services across the specialized service lines.

Responsibilities

• Evaluates prebill hospital inpatient coding compliance edits.
• Summarizes quality review results for Coding Managers and Supervisors.
• Participates in team meetings with coding personnel.
• Reviews, researches, and responds to coding inquiries from other departments.
• Serves as the subject matter expert on diagnosis and procedure codes.
• Provides details specific to audit trends for ongoing education.
• Notifies coding leadership of trends and topics for education.
• Assists with identification and implementation of process improvements.

Requirements

• High School Diploma/GED with 5 years of Franciscan coding experience in lieu of degree.
• Associate's Degree.
• 5 years Coding Experience relevant to auditing specialty with RHIT/RHIA.
• 5 years Franciscan coding experience relevant to the auditing specialty with CCS.
• 2 years Coding Support role with RHIT/RHIA (Preferred).