Senior Health Information Management Inpatient Coding Auditor

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

📋 Description

• Lead teams of coders.

• Provide training and mentorship to coders on the proper application of ICD-CM and ICD-PCS guidelines.

• Oversee daily work queues by prioritizing and assigning inpatient accounts for coding within specified timelines.

• Perform prebill and retrospective audits on discharged inpatient records to confirm coding and DRG assignments.

• Record audit findings to enhance CC/MCC capture, risk variable capture, HAC/PSI, HCC, and validation of quality indicators.

• Recognize issues related to documentation, coding, reimbursement, and compliance, and communicate trends to coding leadership.

• Coordinate queries regarding provider documentation for the Clinical Documentation Integrity team.

• Collaborate and consult with clinical documentation specialists on coding and documentation practices.

• Create and maintain coding curricula and training materials.

• Develop educational programs for coding, clinical documentation, and medical staff, which include annual updates on coding/DRG.

• Assign ICD and ICD-PCS codes along with DRGs for inpatient records, including major traumas and NICU cases.

• Verify DRGs, MCCs/CCs, HACs, and PSIs; select principal diagnoses and assign POA indicators and risk-adjustment diagnoses.

• Review and address inpatient denials, assisting with coding and clinical validation denials.

• Support management in resolving coding issues, enhancing processes, and testing HIM application systems.

• Engage in the CDI-Coding Task Force and participate in collaborative training with CDI, PFS, specialty areas, and Quality.

• Undertake additional responsibilities as assigned.

⛳️ Requirements

• Associate degree or Coding Certificate from an accredited American Health Information Management (AHIMA) or equivalent coding certification program.

• Minimum of four (4) years of experience in inpatient coding and abstracting, along with knowledge of healthcare billing processes in an acute care environment.

• Required credential: Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), Certified Coding Specialist (CCS), Certified Inpatient Coder (CIC), or other recognized coding certifications.

• Familiarity with electronic medical records and knowledge of the 3M or Encoder System.

• Understanding of medical terminology, basic anatomy and physiology, pathophysiology, and pharmacology, with the capability to apply this knowledge to coding.

• Knowledge of the MS DRG prospective payment system and severity systems.

• Proficient in clinical documentation improvement principles, quality indicators, and both formal and informal coding audit methods.

• Ability to work efficiently and autonomously while managing multiple demands consistently.

• Strong computer skills, including proficiency in spreadsheets and databases.

• Capacity to apply broad guidelines to specific coding circumstances independently, exercising discretion and substantial analytical skills.

🏝️ Benefits

• Full-time employment.

• Day shift schedule.

• Remote work option as indicated in the job title.

• Opportunities to participate in on-site, remote, and/or external training workshops.