The Coding Auditor is proficient in various types of coding and is responsible for performing coding quality audits, providing feedback to coders, and educating coders. The Coding Auditor utilizes the International Classification of Disease (ICD-10-CM. ICD-10-PCS), Healthcare Common Procedure Coding System (HCPCS) including Current Procedural Terminology (CPT) and other coding references to ensure accurate coding. Coding references will be used to ensure accurate coding and grouping of classification assignment (e.g., MS-DRG, APR-DRG, APC etc.) The Coding Auditor reviews, researches, and processes billing edits. The Coding Auditor may provide coverage for the Coder positions as needed.
ESSENTIAL FUNCTIONS OF THE ROLE
Performs routine coding quality reviews on all coders and/or auditors including third party suppliers as appropriate.
Performs coding quality reviews in collaboration with or for internal customers of the organization.
Provides feedback and education as appropriate depending on findings.
Abstracts and validates required data elements into the coding and abstracting system.
Reviews, researches, and processes billing edits working collaboratively with revenue cycle departments to ensure coding and edits are processed timely and accurately.
Works collaboratively with the Clinical Documentation Specialists and Coaches to communicate opportunities for accurate, complete, and compliant documentation.
Completes production coding when needed and assigned by one over.
KEY SUCCESS FACTORS
Strong knowledge of applicable rules, regulations, policies, laws and guidelines that impact the coding area.
Strong knowledge of transaction code sets, HIPAA requirements and other issues impacting the coding and abstracting function.
Strong knowledge of anatomy, physiology, and medical terminology.
Demonstrated competency of the use of computer applications, group software and Correct Coding Initiatives (CCI) edits.
Strong knowledge of ICD-10 diagnosis and procedural coding and Current Procedural Terminology (CPT) procedural coding.
Ability to interpret health record documentation to identify procedures and services for accurate code assignment.
Strong interpersonal verbal and written communication skills.
Skill in the use of computers.
Flexibility and adaptability while also balancing requirements and regulatory and accreditation guidelines that are non-negotiables.
Must possess one of the following certifications and 1 year of the experience should be as a coding auditor:
Registered Health Information Administrator (RHIA) Registered Health Information Technologist (RHIT) Certified Coding Specialist (CCS) Certified Coding Specialist Physician-based (CCS-P) Certified Professional Coder (CPC) Certified Outpatient Coder (COC) Certified Inpatient Coder (CIC) Certified Interventional Radiology Cardiovascular Coder (CIRCC)
Our competitive benefits package includes the following - Immediate eligibility for health and welfare benefits - 401(k) savings plan with dollar-for-dollar match up to 5% - Tuition Reimbursement - PTO accrual beginning Day 1 Note: Benefits may vary based upon position type and/or level
- EDUCATION - H.S. Diploma/GED Equivalent
- EXPERIENCE - 5 Years of Experience
- CERTIFICATION/LICENSE/REGISTRATION - Cert Coding Specialist (CCS), Cert Coding Spec Physician Bas (CCS-P), Cert Inpatient Coder (CIC), Cert Interv Radiology CV Coder (CIRCC), Cert Outpatient Coder (COC), Cert Professional Coder (CPC), Reg Health Info Administrator (RHIA), Reg Health Information Technic (RHIT): One of the following required: Cert Professional Coder (CPC) Cert Outpatient Coding (COC) Cert Inpatient Coder (CIC) Cert Coding Spec (CCS) Reg Health Info Tech (RHIT) Reg Health Info Admin (RHIA) Cert Interventional Radiology Cardio Coder (CIRCC) Cert Coding Spec Phys (CCS-P).
Baylor Scott & White Health (BSWH) is the largest not-for-profit health care system in Texas and one of the largest in the United States. With a commitment to and a track record of innovation, collaboration, integrity and compassion for the patient, BSWH stands to be one of the nation’s exemplary health care organizations. Our mission is to serve all people by providing personalized health and wellness through exemplary care, education and research as a Christian ministry of healing. Joining our team is not just accepting a job, it’s accepting a calling!