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PreviousQuality Coding Auditor - Not a Remote Position (Relocation... & Sign On Bonus Eligible
The Quality Coding Auditor of Revenue Cycle will conducts monthly quality coding audits. The audit will contain both a qualitative and quantitative focus, correct assignment of ICD-10-cm PCS 10-cm and CPT codes and clinician documentation to ensure that Healthcare medical records meet all federal/state mandatory regulatory guidelines and KP internal controls.
· Develop and preform audits to help determine and validate documentation and coding issues and gaps, analyzes audit results and identifies patterns, trends and variations in coding and documentation practices and make recommendations for improvement. Develop and implement training when educational needs have been identified
· Provide identified documentation issues to Documentation Coding Services (DCS) educators regarding any gaps in documentation that facilitates coding issues. Provide coding audit outcomes to Coding management teams. Work with the Coding management team to develop a remediation plan.
· Work with the Coding leadership in development of policies and controls to support appropriate coding. Work with the Revenue Cycle on other audit within the revenue service
· Maintain current knowledge of coding, federal and local regulations. Perform other duties as assigned.
· Minimum three (3) years of coding experience of applying diagnoses and procedure codes to medical records, including Medicare, Medicaid, and third party payor billings
· Associate's degree in health information management, business administration, finance, health administration or other related field OR two (2) years of experience in a directly related field.
· High School Diploma or General Education Development (GED) required.
License, Certification, Registration
· Credential in one or more: Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Coding Specialist (CCS), Certified Coding Specialist-Physician (CCS-P) at time of hire/transfer, Certified Professional Coder (CPC), Certified Outpatient Coder (COC).
· Must maintain above registration or certification status.
· Extensive knowledge of ICD-10-CM and CPT coding and clinician documentation.
· Knowledge of governmental coding regulations and areas of scrutiny for potential areas of risk for fraud and abuse.
· Knowledge in both inpatient and outpatient medical coding.
· Excellent interpersonal communication skills (written and verbal) to deal effectively in delicate, sensitive and/or complex situations with a wide variety of influential internal and external parties.
· Excellent problem solving and time management skills.
· Excellent customer service skills.
· Minimum five (5) years of applying diagnoses and procedure codes to inpatient and outpatient medical records, including Medicare, Medicaid, and third party payor billings.
· Minimum two (2) years in performing peer review audits and quality performance measures.
· Experience with Microsoft Office, including Access, Excel, Word, and PowerPoint.
· Bachelor's degree in health information management, business administration, finance, health administration or other related field, OR four (4) years of experience in lieu of a preferred degree.
· Current credential in one or more of the following: Registered Health Information Administrator (RHIA),Registered Health Information Technician (RHIT), Certified Coding Specialist (CCS), Certified Coding Specialist-Physician (CCS-P), AHIMA ICD 10 trainer
· A thorough working knowledge of disease processes, diagnostic and surgical procedures, ICD-10CM and CPT coding applications, and HIM department responsibilities of government regulations and areas of scrutiny for potential fraud and abuse.
· Working knowledge of the Encoder, EpicCare, and KARE systems.
Yes, 5 % of the Time
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