Senior Audit Specialist
Job Locations: US-Remote
Requisition ID: 2019-8470
# of Openings: 1
Category (Portal Searching): HIM / Coding
The Auditing Specialist will respond to consulting and education needs related to coding quality, compliance assessments, external payer reviews, coding education, interim coding management and coding workflow operations reviews. Offer meaningful information to meet customer expectations including identifying and proposing solutions for customer issues. Develop and maintain account relationships through responsiveness and calm, reflective work practices. Work cooperatively with the Data Quality & Coding Compliance leadership and scheduling for optimal services outcome.
- Performs inpatient and outpatient coding audits medical records and abstracts using ICD-10-CM CPT and appropriate coding references for appropriate DRG and APC assignment.
- Reviews non-CC/MCC records to determine if the record was properly coded or if additional documentation is needed. Reviews all HCPCS and CPT codes impacting APC assignment
- Provides coder education via the auditing process
- Prepares preliminary results for review by the facility or CCS HIM director
- Reviews APC/DRG change disagreements with appropriate manager
- Prepares the final reports for the coding audit. Participates in settlement of audit findings.
- Provides coder education via email and/or conference call using the audit spreadsheet findings and comments
- Attends coding workshops as necessary
- Keeps abreast of regulatory changes
- Organizes and prioritizes multiple cases concurrently to ensure departmental workflow and case resolution
- Shows versatility and exemplary work including a wide range of services coded
- Meets with client facility representatives to discuss issues and trends identified in audit
- Develops and implements education for physician, nursing, and other clinical staff to improve documentation
- Demonstrate initiative and judgment in the performance of job responsibilities
- Communicates with co-workers, management, and hospital staff regarding clinical and reimbursement issues
- Function in a professional, efficient and positive manner
- Adhere to the American Health Information Management Association’s code of ethics
- Must be customer-service focused and exhibit professionalism, flexibility, dependability, desire to learn, commitment to excellence and commitment to profession
- Audits external coding staff as needed and provides reports to manager as directed
- High complexity of work function and decision making
- Strong organizational, teamwork, and leadership skills
- Minimum of 3 years experience coding or auditing
- CCS and RHIA or RHIT credentials preferred
- Recent experience in academic/level 1 trauma centers
- Experience coding or auditing inpatient and outpatient records for various facilities
- Track record of acceptable productivity standards
- Maintain 95% accuracy rate for APC assignment and 95% productivity rate
- Experience with various software including EMR, Encoder and Auditing software
Over 90% of the time is spent indoors, with protection from weather conditions. Exposure to noise levels that may be distracting or uncomfortable is present in only unusual situations.
Sitting, talking, hearing and near vision are required over 90% of the time, while walking is required about 10% of the time. Standing is required over 30% of the time. The sense of touch is required 90% of the time and reaching is required about 50% of the time. Bending, twisting, and climbing are required, as is far vision, but only for 10% or less of the time. Low levels of lifting (10 pounds or less) are required about 25% of the time, while medium levels (20 to 40 pounds) of lifting and carrying are required less than 5% of the time. High levels (52 pounds) of lifting are required under 2% of the time. Driving is a considerable portion of the position.