Lead Coding Services Auditor

Role Overview

• The Lead Coding Services Auditor is responsible for conducting prebill and retrospective reviews to include, but not limited to, focused reviews on identified opportunities, mortality, PSI (patient safety indicators) and coder focused audits.
• Reviews include full DRG validation, review of assigned ICD-10-CM/PCS, POA indicator(s), validation of all abstracting elements, review for query opportunities affecting DRG, severity of illness, and/or risk of mortality scores.
• Auditor will use Vizient risk adjustment tools to identify potential coding opportunities during chart reviews.
• All audits performed ensure compliance with current coding guidelines and regulatory standards.
• Will use critical thinking skills and knowledge of coding/compliance guidelines to identify potential documentation, coding and reimbursement issues and report these to the leadership.
• Serves as a mentor for the auditing team providing expert level expertise and feedback to the auditing and leadership team.
• Will represent the auditing team in meetings within and outside the department on subject matter within the owning area.
• Create and maintain detailed data logs and trend and produce data in a meaningful executive style format for presentation.
• Perform lead duties in support of team in regard to data and reporting to include but not limited to: produce monthly reports and maintains dashboards from multiple systems, maintains other logs and spreadsheets (i.e.: CFB email, PSI log), maintain updated data needed by team (i.e.: Vizient Data), update written processes as directed by Data Quality Manager.

Requirements

• Associate's Degree in Health Information Management, Business, or other health care related field (required)
• Bachelor's Degree in Health Information Management, Business, or other health care related field (preferred)
• All certifications are required upon hire unless otherwise stated.
• Cert Coding Spec-Preferred or Reg Health Information Admin-Preferred or Reg Health Information Tech-Preferred
• Minimum 1 year Served in a Coding Auditor Role at Wellstar for at least one year, is fully trained and maintains a accuracy in all areas within scope of work (Required)
• Minimum 3 years Hospital-based inpatient auditing experience currently meeting a accuracy in abstracting, coding and DRG assignment while meeting productivity requirements or passing score on the coding assessment provided by Coding department, if applicable. (Required)
• Extensive knowledge of medical terminology, disease processes, pharmacology, anatomy and physiology. High
• Must have excellent organizational skills and be able to manage multiple tasks at one time, set priorities and achieve goals timely. High
• Ability to learn and efficiently use various software systems: EPIC, 3M360, Institutional Audit Manager, Vizient, Cloudmed, Outlook, Teams and text messaging. High
• Ability to articulate & communicate verbally & via email to achieve an objective & with critical thinking skills High
• Able to identify creative, out of the box solutions to complex problems, analyze issues and opportunities to achieve and provide feedback and implement solutions to achieve a successful result. High
• Serve as a mentor to the team, taking time to assist and being a source of information and insight. Provide an exchange of knowledge, experience and goodwill to assist in growth for the team member High
• Previous PSI (Patient Safety Indicator) auditing experience preferred. Medium

Benefits

• 10k Sign-On Bonus Available