Coding Quality Auditor, CT

A 300+ bed hospital located on the Eastern seaboard of CT has a need for a Coding Quality Auditor to join their team.This position is directly responsible for assuring the accuracy, consistency, efficiency and regulatory compliance with inpatient and outpatient coding to optimize DRG and APC reimbursement.

Required Skills

Develop, maintain and monitor the HIM coding quality review plan.

Perform regular coding data quality reviews on inpatient and/or outpatient records.

Develop and coordinate educational and training programs regarding elements of the coding quality review plan, such as appropriate documentation and accurate coding to all appropriate personnel.

Monitor Medicare and other regulatory bulletins and manuals and reviews the current OIG work plans for DRG and coding risk areas.

Manages post discharge clarification process and minimizes impact on account receivable days.

Responsible for regular review of 3rd party edits, and preparing and delivering corrective action. Monitors denied claims reports attributed to HIM to correct ongoing issues that are resulting in denials.

Act as a liaison between, coding team, CDI specialists and physicians to support the Clinical Documentation Improvement program.

Demonstrates competency in the use of computer applications and DRG grouper software, Medicare edits and all coding and abstracting software and hardware currently in use by the HIM department.

Serves as the facility representative for coding/clinical data management by attending coding and reimbursement workshops and brings back information to the appropriate departments. Communicates any DRG, coding updates published in bulletins and provider manuals.

Required Experience

Must have a minimum Associate’s degree in related clinical science studies plus be certified with the following current credentials: CCS or CPC or RHIA or RHIT.

Previous auditing experience or minimum of 5 years recent inpatient and 3 years recent outpatient facility coding experience with strong understanding of PPS, inpatient DRG assignment and disease processes.

Ability to interact effectively and professionally with physician, other health care professionals, managers, executives and various support staff.

This city in New England is made up of approximately 45 distinct neighborhoods, including two historic districts. It is considered the safest city in New England and the 11th safest city in the United States. Commuter trains come into the city from all points between New London, CT to the east of New York (Grand Central Terminal) to the south. The Town Center boasts 130 shops and restaurants and there are 118 unique street level stores in each of the neighborhoods. There are more than 85 restaurants, four major hotels and 18 movie screens. It has three parks, some with beaches, marina, tennis courts, softball fields, horseshow pits, playgrounds, skating rink, picnic areas, fishing, and more. Science and nature lovers can enjoy the Museum & Nature Center. A nearby town is home to over 144,000 residents, 1,300 acres of public land for parks, 13 officially delineated neighborhoods across 16 square miles of land. Landscapes, highways, and communities define the neighborhoods. The town offers a wealth of attractions: majestic shoreline parks, fascinating museums, regional baseball, hockey, and festivals and national musical acts and performances.

Salary starts out around $60-70K.

For more information,

Contact: Tina Roberts, President
588 Sutter Street, Suite 349
San Francisco, CA 94102
(415) 770-1200    (415) 684-2526


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