Health Information Management Inpatient Coding Auditor Senior
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Role Description
This expert level inpatient senior coding analyst is responsible for coder training, work queue management, performing second-level coding reviews utilizing auditing software, and documenting findings to improve MCC/CC, HAC/PSI, HCC, and Quality Indicator validation.
Conducts review and audit of discharged inpatient records (prebill and retrospective reviews) to validate the coding/DRG assignment according to official coding guidelines as supported by the clinical documentation in the record.
Monitors work queues daily to identify, prioritize, and assign accounts that need to be coded based on department-specific guidelines and within designated timelines in coordination with leadership.
Mentors and trains coders on application of correct ICD-CD and ICD PCS guidelines.
Coordinates and identifies provider documentation queries for the Clinical Documentation Integrity team to send to clinical providers.
Consults, provides professional expertise to, and collaborates with clinical documentation specialists on coding and documentation practices and standards.
Assists with and develops educational programs for coding staff, clinical documentation staff, and medical staff including yearly coding/DRG updates.
Applies ICD and ICD-PCS codes including major traumas and Neonatal Intensive Care Unit (NICU) records based on review of clinical documentation.
Identifies and assists management with the resolution of coding issues, process improvement, and system testing for HIM applications.
Interacts with other departments to resolve coding issues and assists with coding and clinical validation denials.
Participates in on-site, remote, and/or external training workshops and training.
Performs other duties as assigned.
Qualifications
Associate's degree or Coding Certificate through approved American Health Information Management (AHIMA) or other coding certification program.
4 years of experience in inpatient coding and abstracting with healthcare billing process experience in an acute care setting.
Demonstrated high coding accuracy and productivity.
Requirements
Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), Certified Coding Specialist (CCS), Certified Inpatient Coder (CIC) or other approved coding credential.
Knowledge of electronic medical records and 3M or Encoder System.
EPIC health information system experience (preferred).
Strong knowledge of medical terminology and basic anatomy and physiology, pathophysiology, and pharmacology with the ability to apply this knowledge to the coding process.
Knowledge of MS DRG prospective payment system and severity systems.
Knowledge of Clinical Documentation Improvement principles, quality indicators, formal and informal coding audit process.
Ability to work effectively, independently and manage multiple demands consistently.
Proficient computer skills (spreadsheets and database).
Ability to apply broad guidelines to specific coding situations, independently utilizing discretion and a significant level of analytic ability (preferred).
Benefits
Comprehensive health insurance
401(k) with company match
Company Description
Prisma Health is the largest not-for-profit health organization in South Carolina, serving more than 1.2 million patients annually. Our 32,000 team members are dedicated to supporting the health and well-being of you and your family.
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