Inpatient Coding Auditor

This is a fully remote position, open to applicants in Illinois.

📋 Description

• Accountable for auditing inpatient coders and/or conducting “audit the auditors” to guarantee coding accuracy and a DRG accuracy threshold of at least 95% is achieved.

• Execute quality checks/audits on visits coded according to client Standard Operating Procedures (SOPs).

• Carry out calibration audits.

• Recommend enhancements and arrange calibration sessions with offshore team counterparts and leadership.

• May contribute to the preparation of audit reports, provide direct feedback to coders and auditors regarding improvement areas, and engage in client interactions and internal stakeholder meetings.

• Possess a solid understanding of clinical documentation guidelines.

• Oversee compliance with coding guidelines, ensuring that errors identified during audits are corrected appropriately, and initiate corrective actions before claims are resubmitted to insurance.

• Perform analyses and present summaries of findings to leadership in a clear, concise, persuasive, and actionable manner.

• Utilize encoder software applications, including all relevant online tools and references for assigning International Classification of Diseases, Clinical Modification (ICD-CM) diagnosis and procedure codes (ICD-PCS), MS-DRG, APR DRG, POA, SOI & ROM assignments.

• Ensure accurate code capture/reporting by applying coding guidelines established by: The Centers for Disease Control (CDC), ICD-CM Official Coding Guidelines for Coding and Reporting, Centers for Medicare/Medicaid Services (CMS) ICD-PCS Official Guidelines for Coding and Reporting, American Hospital Association (AHA) Coding Clinic for International Classification of Diseases, Clinical Modification, and American Health Information Management Association (AHIMA) Standards of Ethical Coding along with client coding procedures and guidelines.

• Navigate the patient health record and other computer systems/sources to accurately ascertain diagnosis and procedure codes, MS-DRGs, APR DRGs, and identify HACs and PSIs or other indicators that may affect quality data and hospital reimbursement.

• Review inpatient health record documentation to evaluate the presence of clinical evidence/indicators supporting diagnosis codes and MS-DRG, APR DRG assignments to potentially reduce denials.

• Uphold a high standard of professional and ethical conduct.

• Focus on enhancing coding skills, knowledge, and accuracy by engaging in coding team meetings and educational conferences.

• Maintain Continuing Education Units (CEUs) as required for coding credentials as stipulated by credentialing associations.

• Stay updated on changes in inpatient reimbursement guidelines and regulations as well as new applications or settings for inpatient coding, such as Hospital at Home.

• Ensure patient information is accurate and that all medical records contain the necessary signatures.

• Demonstrate knowledge of current, compliant coder query practices when consulting with physicians, Clinical Documentation Specialists (CDS), or other healthcare providers when additional information is required for coding and/or to clarify conflicting or ambiguous documentation.

• Maintain familiarity with applicable coding and reimbursement Federal, State, and local regulations, the Code of Ethics, and other policies and procedures to ensure compliance in a manner that reflects honesty, ethical behavior, and professionalism.

• Perform additional duties as assigned.

⛳️ Requirements

• Current permanent United States Work Authorization is required.

• Must work a day shift schedule within the United States.

• At least 2 years of previous experience as an inpatient coding auditor.

• A minimum of 3 years of prior experience in coding inpatient hospital accounts.

• Advanced proficiency in the Microsoft Office suite (Excel, Word, PowerPoint, Outlook, Visio, SharePoint).

• Strong analytical skills (problem-solving, quantitative analysis, workflow processes, etc.).

• Exceptional attention to detail; strong follow-up and follow-through capabilities.

• Excellent time management abilities; organized with the capacity to prioritize multiple tasks within a deadline-driven environment.

• Requires independent judgment, discretion, and decision-making skills.

• Ability to interact with both internal and external customers in a professional manner.

• Capability to quickly familiarize oneself with a client’s environment, processes, historical context, and systems to provide timely support to an engagement.

• Required financial acumen and analytical skills.

• Preferred experience working with data from a variety of sources.

• Familiarity with revenue cycle systems, comprehensive understanding of revenue cycle process flow, and financial analysis.

• Willingness to work collaboratively as part of a team in a partnership role.

• Strong oral and written communication skills, analytical capabilities, ability to work independently, and self-motivation are essential.

• Must be flexible and adaptable to changes.

🏝️ Benefits

• Comprehensive medical, dental, and vision coverage.

• 401(k) plan with an attractive employer match.

• Employee stock purchase plan.

• Generous Paid Time Off policy.

• Paid parental leave and adoption assistance.

• Complimentary annual health screenings and coaching.

• Ongoing programs recognizing significant life events for employees throughout the year.