Position Summary

Seeking a highly skilled and experienced Revenue Integrity Coding Auditor to join our dynamic team. The ideal candidate should possess a Certified Coding Specialist (CCS) or Certified Professional Coder (CPC) certification and a minimum of 3 years of Inpatient and/or Outpatient coding experience. The Revenue Integrity Coding Auditor will play a crucial role in ensuring accurate coding, MS-DRG assignment, and compliance within our healthcare organization.

Work Schedule

Full-time 40-hour work week – Monday – Friday

Primary Duties

• The Revenue Integrity Coding Auditor will be responsible for the following key areas, including but not limited to:

  Review Activities:

  – Conduct reviews of Clinical Documentation Improvement (CDI) Mismatches.

  – Evaluate responses to Late Query submissions.

  – Assess Besler Quality Recommendations.

  – Examine coding issues related to Medical Necessity and other concerns.

  – Investigate MS-DRG Denials.

  – Conduct Coding Compliance Research.

  – Perform RVU Analysis.

  – Review high-risk cases such as Impella, TCAR, Aveir DR.

  – Handle Rebill Requests.

  – Address Discharge Not Final Billed Reports.

  – Provide continued support for Charge review.

  Collaboration:

  – Work closely with Providers, Clinical, Coding, and CDI team members.

  – Respond to coding questions and collaborate with CDI QA team on DRG reconciliation.

  – Collaborate with the Director of HIM/Coding/Billing regarding coding quality and education recommendations.

  Auditing and Reporting:

  – Perform random and focus-selected medical records review for accurate coding and MS-DRG assignment.

  – Summarize audit findings and provide feedback to the Director.

  – Keep detailed records of audits, results, recommendations, and follow-up actions.

  Training and Education:

  – Assist in the training of new coding team members.

  – Contribute to educational activities for all coding team members.

  – Provide education to providers on coding updates, documentation standards, and summary reviews.

  External Audits:

  – Review and respond to third-party coding audits/reviews.

  Benefits:

  The successful candidate will contribute to the organization’s overall efficiency, resulting in benefits such as:

  – Increased efficiency in coding processes.

  – Lowering Days Not Final Billed (DNFB).

  – Decreasing Accounts Receivable (AR) days.

  – Providing research support for coding and RVU-related questions.

  – Improving cash flow.

  *Note: This job description is subject to change as the needs of the organization evolve.*

Qualifications/Specifications

• Education: High School diploma or equivalent required.
• Licensure/Certification: Certified Coding Specialist (CCS) or Certified Professional Coder (CPC) certification required
• Experience: Minimum of three years of experience in medical coding with ICD-10 and CPT coding systems required. Detail-oriented and experienced coding professional with a passion for ensuring accuracy and compliance.