HIM Coding Auditor

Vail Health has become the world’s most advanced mountain healthcare system. Vail Health consists of an updated 520,000-square-foot, 56-bed hospital.  This state-of-the-art facility provides exceptional care to all of our patients, with the most beautiful views in the area, located centrally in Vail. Learn more about Vail Health here.

Some roles may be based outside of our Colorado office (remote-only positions). Roles based outside of our primary office can sit in any of the following states: AZ, CO, CT, FL, GA, ID, IL, KS, MA, MD, MI, MN, NC, NJ, OH, OR, PA, SC, TN, TX, UT, VA, WA, and WI. Please only apply if you are able to live and work primarily in one of the states listed above. State locations and specifics are subject to change as our hiring requirements shift.   About the opportunity:

This position audits the activities of the Coding Specialists and Providers to ensure accurate coding that achieves organizational quality and financial expectations. Works with the Coding Manager to plan work, organize resources, motivate, and monitor staff performance through quality audits. Reads patient records in accordance with Governmental, third-party payer, and facility rules and regulations, accurately assigns and sequences ICD-10-CM diagnosis, ICD-10-PCS procedural codes and/or CPT E&M and procedural codes to inpatient and outpatient records for use in reimbursement and data collection.

What you will do:

1. Conducts monthly reviews of coding quality by auditing pre and post bill records for coding compliance and records quality for each coder. Reviews findings with the individual coding specialists and, when appropriate, provides education to address deficiencies. Tracks and reports findings to the Coding Manager.
2. Conducts quarterly reviews of coding quality and records quality for each assigned provider. Reviews findings with the individual providers or provider groups and, when appropriate, provides education to address deficiencies. Competent in accessing and using an encoder (3M). Tracks and reports findings to the Coding Manager.
3. Competently performs all duties of a Coding Specialist III.
4. Collaborates with others in the organization including Medical Staff, other clinicians, and physician office staffs; and with Patient Financial Services to ensure the codes submitted for claims are supported by the documentation in the record. When querying clinical staff, uses appropriate querying techniques to avoid leading the clinician and follows up to ensure queried accounts are dropped within 10 days of the query. As needed, involves the department leader. Participates in various hospital/physician committees as appropriate and prepares and provides provider in-services.
5. Attends all required in-services and coder meetings. Identifies and attends training and educational programs conducive to professional growth. Utilizes current literature and workshops attended to the benefit of the organization. New ideas, policies, regulations, and philosophies are adapted to current policies and procedures appropriately. Shares coding policies, procedures, and coding guidance routinely with staff. As necessary, tests staff on their level of understanding the shared materials. Arranges for routine in-service options for coding staff. Locates CMS and third-party payer websites for coding requirements and medical necessity guidelines.
6. Supports the philosophy, objectives, and goals of the organization and department by volunteering in various capacities without compromising performance expectations. Role models the principles of a Just Culture.
7. Contributes to the efficiency of the department. Routinely volunteers to assist others when work is completed.
8. Routinely abides by standards of professional and ethical conduct as defined by CMS, AHIMA, and the professional organization from which the incumbent is certified and/or credentialed.
9. Understands and complies with policies and procedures related to medicolegal matters including confidentiality, amendment of medical records, release of information, patient rights, medical records as legal evidence, informed consent, etc. Is knowledgeable of and complies with HIPAA, Safety and Compliance Program Policies and Procedures.
10. Role models the principles of a Just Culture and Organizational Values.
11. Performs other duties as assigned. Must be HIPAA compliant.

This description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills and efforts or work conditions associated with the job. It is intended to be an accurate reflection of the general nature and level of the job.   What you will need:   Experience:

• 5 years coding experience in an acute care setting coding all types of hospi