Inpatient Coding Auditor

Job Purpose

**Responsibilities**:

- Collaborate with internal staff to enhance documentation, coding, and compliance
- Review and assess coding quality on accounts completed by Medical Coders
- Review clinical documentation to ensure it supports the codes assigned and meets necessary documentation standards
- Ensure adherence to workflows and ethical coding standards
- Utilize advanced knowledge of ICD-10-CM and ICD-10-PCS coding concepts
- Communicate review findings and recommendations to management
- Assess risk and obtain necessary statistics for coding areas
- Administer the Quality Monitoring Program to meet quality standards and targets
- Manage daily operational processes for quality, efficiency, and productivity
- Utilize data analytics to identify trends and patterns in coding errors, proactively addressing issues and improving overall coding quality
- Collaborate with workgroups to resolve customer-impacting issues
- Seek continuous improvement and development opportunities for the team
- Address complaints, questions, and queries as necessary
- Document team members’ performance and targets
- Monitor systems for optimal performance
- Stay updated on guideline changes, laws, and regulations affecting documentation and reimbursement
- Promote teamwork and service excellence within the department
- Participate in performance improvement activities
- Establish and maintain a formalized review process for compliance with contractual agreements on accuracy rates
- Recommend strategies to achieve high compliance with quality management plans
- Participate in calls/meetings to address performance and training improvements
- Assist in training sessions for new hires and provide refresher trainings as needed
- Ensure compliance with all Med-Metrix policies and procedures
- Identify high-risk areas in coding and develop strategies to mitigate these risks
- Provide feedback to management on potential problems and improvement areas
- Demonstrate exceptional attention to detail and accuracy in reviewing and analyzing medical records
- Possess strong analytical skills to identify trends, patterns, and areas for improvement in coding practices
- Use, protect and disclose patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards
- Understand and comply with Information Security and HIPAA policies and procedures at all times
- Limit viewing of PHI to the absolute minimum as necessary to perform assigned duties

**Qualifications**:

- Hold AAPC and/or AHIMA certification, with CPMA being advantageous
- Minimum of 3-5 years of Coding and auditing.
- Equivalent work experience may be considered in lieu of professional credentials
- Demonstrated knowledge of HIPAA in Medical Coding
- Demonstrated knowledge and understanding of professional reference materials, such as Coding Guidelines and Coding Clinic
- Must be able to use job related software
- Ability to work in a team environment and adapt to changing responsibilities
- Self-starter capable of working independently and within a team
- Ability to prioritize work and remain calm under pressure
- Proficiency in Microsoft Office Suite
- Strong interpersonal skills, ability to communicate well at all levels of the organization
- Strong problem solving and creative skills and the ability to exercise sound judgment and make decisions based on accurate and timely analyses
- High level of integrity and dependability with a strong sense of urgency and results oriented
- Excellent written and verbal communication skills required
- Gracious and welcoming personality for customer service interaction

Working Conditions
- Physical Demands: While performing the duties of this job, the employee is occasionally required to move around the work area; Sit; perform manual tasks; operate tools and other office equipment such as computer, computer peripherals and telephones; extend arms; kneel; talk and hear.
- Mental Demands: The employee must be able to follow directions, collaborate with others, and handle stress.
- Work Environment: The noise level in the work environment is usually mínimal.