Facility Outpatient Surgical and Claims Edit Auditor

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What will I be doing in this role?

The Coding Auditor works under the general direction of the Coding Supervisor. A Coding Auditor is responsible for reviewing encounters in either a prebill or retrospective workflow to validate a coding profile. This includes applicable code sets to encounter type, abstracted data elements, missed query opportunities, and other related encounter data collection points. Auditors evaluate compliance with all coding guidelines including but not limited to: Internal Coding policies/procedures/handbook, American Hospital Association (AHA) and American Medical Association (AMA) coding references, local, State, and Federal Coding Guidelines. Duties include:

• Performs quality coding reviews or audits within established departmental productivity and accuracy standards. Assists with processing re-bills post coding audit changes and assists with coding corrections needed from billing department.
• Provides written summary reports of findings.
• Coordinates and leads 1:1 or small group feedback sessions based on recommendations
• Maintains appropriate open communication with internal and external partners and peer departments such as Coding Operations, Clinical Documentation Integrity (CDI), Payor Revenue Management (PRM), and Compliance Revenue Integrity (CRI).
• Assist peer departments with production coding of cases during shortage of staff.
• Assist in improved data quality for reporting and research, accurate billing and reimbursement of services rendered which overall improves the quality of care for the patient.
• Provide 1:1 and small group education sessions, facilitate round table discussions, contribute content to the coding newsletter, provide basic level trending or data review for opportunities.
• Evaluate codes through data reports and trended opportunities, audit to validate findings, produce summary reports with recommendations of action plans.
• Perform additional activities (e.g. Data quality reports, etc.) as assigned by the Coding Supervisor.

Originally posted on Himalayas