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Coding Compliance Auditor, Full Time, MSS Miramar FL: MDIV - Health Information Mgmt

Company: Memorial Healthcare System
Location: Miramar
Posted on: September 17, 2022

Job Description:

Summary:Responsible for auditing coded inpatient or outpatient medical records applying ICD-10 CM/PCS and/or CPT-4. Reviews Ambulatory Payment Classification (APC), Medicare Severity Diagnosis Related Groups (MSDRG) and All Patients Refined Diagnosis Related Groups (APRDRG) assignment and queries following official coding guidelines and regulatory requirements. Provides training and education based on audit results and any regulatory changes that effect Federal, State and American Health Information Management Association (AHIMA) guidelines. Detailed responsibilities:--- Conducts and reports on electronic medical record audits to verify ICD-10CM/PCS, CPT and APC, MSDRG, and APRDRG coding and grouping accuracy. Serves as an expert resource for all coding staff. Assists with developing specific departmental goals, standards, and objectives which directly support the strategic plan and vision of the organization.--- Holds educational sessions for coding specialists, documentation specialists, and physicians. Acts as a liaison for electronic physician query process. Utilizes coding audit results to tailor education to increase coding accuracy. Assists the coding staff to format compliant queries and assesses for compliance with AHIMA query standards. Reports results of coding and query compliance audits to management.--- Coordinates, develops, and implements coder intern education and training. Training will align with AHIMA standards of ethical coding and official coding guidelines. Provides feedback based on audit results and tracks coder intern progression throughout the program.--- Works closely with inpatient and outpatient coding managers to analyze and resolve claim denials that are rejected by edits from the Revenue Cycle Department. Reviews and responds to all external coding denial audits using ICD-10CM/PCS, CPT and APC, MSDRG, and APRDRG audits.--- Maintains thorough knowledge of ICD-10CM/PCS, and CPT coding principles and guidelines; possesses substantial knowledge of MSDRG, APRDRG, APC, and Enhanced Ambulatory Patient Groups (EAPG) classification systems and query guidelines for compliant provider documentation.--- Maintains strict adherence to patient confidentiality according to MHS standards and regulatory requirements.--- Performs all other duties as assigned. Competencies and skills:Essential:--- STANDARDS OF BEHAVIOR: Acts in a manner that supports the standards of communication, respect, privacy, and teamwork by demonstrating a commitment to professional and ethical conduct. --- CUSTOMER SERVICE: Demonstrates commitment to service excellence by promptly addressing internal/external customer issues/requests, resolving concerns while maintaining a professional image and behavior to build and enhance the patient/family/customer experience.--- ACCOUNTABILITY: Accepts ownership of job roles and specific assignments/goals; works independently, takes responsibility for own actions; admits mistakes and judgment errors; and accepts constructive feedback. Connects personal work results to the accomplishment of team and organizational goals.--- RESPONDING TO CHANGE: Accepts change and adapts in a positive and productive manner; handles unexpected situations and changes in direction calmly and with confidence. Views new assignments and job responsibilities as an opportunity for growth.--- ACCURACY: Completes work assignments within established quality and/or quantity standards. --- EFFECTIVE COMMUNICATION: Communicates effectively with various audiences using the most appropriate method for the situation. --- MEDICAL TERMINOLOGY: Analyzes the basic structure of medical words. --- HUMAN ANATOMY: Recognizes the various parts of the human body and their functions. --- MEDICAL CODING: Transforms verbal descriptions of diseases and procedures into numeric designations. Education:Essential:--- Accredited Program Education specialization:Essential:--- Health Information Management Credentials:Essential:--- Certified Coding Specialist Education equivalent experience:Essential:--- Other information:Complexity of Work: Requires critical thinking, decisive judgment, effective written and verbal communication skills. Demonstrates effective time management skills, professional responsibility and fosters teamwork. Able to work with minimal supervision. Must be able to work in a stressful environment and take appropriate action. Ability to accurately assign and sequence ICD-10-CM/PCS and CPT codes to principal diagnosis and procedures, complications and co-morbid conditions to complex inpatient or outpatient encounters such as observation, outpatient surgery and interventional radiology. Provides guidance to other departmental staff in identifying and resolving coding issues or errors. Proficient in basic computer skills including Microsoft Office applications and utilizing a computerized encoder and electronic medical record systems.Required Work Experience: For inpatient coding auditor, three (3) years of inpatient coding experience. For outpatient coding auditor, three (3) years of outpatient coding experience.Registered Health Information Administrator (RHIA) or Registered Health Information Technician (RHIT) or Certified Coding Specialist (CCS). Working conditions:Essential:--- Bending and Stooping 40.00%--- Keyboard Entry 60.00%--- Kneeling 40.00%--- Lifting or Carrying 0 - 25 lbs Non-Patient 40.00%--- Pushing or Pulling 0 - 25 lbs Non-Patient 40.00%--- Reaching 40.00%--- Repetitive Movement Hand/Arm 60.00%--- Sitting 60.00%--- Squatting 20.00%--- Standing 60.00%--- Walking 60.00%--- Audible Speech 60.00%--- Hearing Acuity 60.00%--- Depth Perception 60.00%--- Distinguish Color 60.00%--- Seeing - Far 60.00%--- Seeing - Near 60.00%--- Computer Monitor 60.00%--- Potential Electric Shock 60.00% Organizational Profile: Memorial Healthcare System, consisting of 6 acute care hospitals, a nursing home, outpatient facilities, home health services and physician practices, provides quality, comprehensive care to the residents of the surrounding communities. We invite you to join one of the nation's leading healthcare systems, recognized for use of advanced technology and clinical informatics. Memorial Support Services provides a variety of business services to support our facilities. The main offices are located in Miramar with satellite offices located throughout our system. Disclaimer: This job description is not intended, nor should it be construed to be an exhaustive list of all responsibilities, skills, efforts or working conditions associated with the job. It is intended to indicate the general nature and level of work performed by employees within this classification.

Keywords: Memorial Healthcare System, Hollywood , Coding Compliance Auditor, Full Time, MSS Miramar FL: MDIV - Health Information Mgmt, Healthcare , Miramar, Florida

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