Inpatient Audit Specialist

Role Overview

• Conduct inpatient coding audits on medical records, utilizing ICD-10-CM, CPT, and appropriate coding references for accurate DRG and APC assignment.
• Review non-CC/MCC records to assess proper coding or identify the need for additional documentation. Scrutinizes all HCPCS and CPT codes influencing APC assignment.
• Provide coder education through the auditing process.
• Prepare preliminary results for review by the facility or CCS HIM director.
• Review disagreements on APC/DRG changes with the appropriate manager.
• Prepare the final reports for the coding audit and actively participates in the resolution of audit findings.
• Provide coder education via email and/or conference calls, utilizing the audit spreadsheet findings and comments.
• Attend coding workshops as necessary.
• Stay current with regulatory changes.
• Organize and prioritize multiple cases concurrently to ensure departmental workflow and prompt case resolution.
• Demonstrate versatility and exceptional work across a wide range of coded services.
• Meet with client facility representatives to discuss issues and trends identified in audits.
• Develop and implement education for physicians, nursing, and other clinical staff to enhance documentation.
• Communicate effectively 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.
• Maintain a customer-service focus and exhibits professionalism, flexibility, dependability, a desire to learn, commitment to excellence, and commitment to the profession.
• Conduct audits on external coding staff as needed and provides reports to the manager as directed.
• Handle a high complexity of work functions and decision-making.
• Demonstrate strong organizational, teamwork, and leadership skills.

Requirements

• 3+ years experience coding and auditing
• Associate or Bachelor's degree from an AHIMA-certified HIM or Nursing Program, or completion of a certificate program from AAPC with a preference for CCS
• Preferred: CCS, RHIT, or RHIA credentials.
• Recent experience in academic/level 1 trauma centers
• Experience coding and 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

Benefits

• Benefits for Full-Time employees: Medical, Dental, Vision, 401k Savings Plan w/match, 2 weeks of paid time off, and Paid Holidays, Floating Holidays
• Free CEUs every year
• Stipend provided to assist with education and professional dues (AHIMA/AAPC) If Applicable
• Equipment: monitor, laptop, mouse, headset, and keyboard
• Comprehensive training led by a credentialed professional coding manager
• Exceptional service-style management and mentorship (we’re in this together!)