HIMS Coding Auditor

Responsible for maintaining coded data quality through ongoing quality review and assessment of outpatient or inpatient records. Performs audits on accuracy of APC or MSDRGs as well as on quality of medical record documentation needed for accurate coding. Works with DRG and CPT denials from commercial payers and writes appeal letters as indicated.

Ensures coding compliance by applying all coding guidelines and principles as defined in the Coding Clinic and leading authorities. Complies with standardized coding standards, conventions, regulations, corporate compliance standards, and reimbursement policies.

Identifies training needs and provides education to team members. May teach or coordinate coding huddles and coaches and mentors staff.

Performs focused reviews and quality audits and prepares audit reports for leadership.

Assists coding leadership with reviewing and responding to internal and external coding audits and works with leadership to settle audit findings.

Monitors and evaluates coding functions to ensure effective and efficient operations, compliance with standards, rules, and regulations.

Audits for documentation opportunities to clarify confusing, incomplete, or conflicting information and obtains additional documentation if needed.

Assists patient financial services and clinical documentation improvement team members with questions on coding and billing edits.

Serves as a clinical coding liaison, analyzing and evaluating documentation issues with consultation from medical staff, clinical staff, CDI team, and other departments.

Assists leadership with coordination of iCare initiatives related to the hospital coding department.

Works on DRG and CPT denials from payers as needed, writes appeals, and documents denials/audits for tracking and reporting.