CRC/DRG Coding Auditor - Remote

JOB SUMMARY 

Conducts data quality audits of inpatient admissions and outpatient encounters to validate coding assignment is in compliance with the official coding guidelines as supported by clinical documentation in health record. Validates abstracted data elements that are integral to appropriate payment methodology. 

ESSENTIAL DUTIES AND RESPONSIBILITIES
Include the following. Others may be assigned.

1. Consulting: Consults facility leaders and staff on best practices, methodology, and tools for accurately coding. 

2. Chart Analysis IP, OP Coding Data auditing and validation: Reviews medical records for the determination of accurate assignment of all documented diagnoses and procedures. Adheres to Standards of Ethical Coding (AHIMA).    Reviews medical records for the determination of accurate assignment of all documented diagnoses and procedures.   Reviews claim to validate abstracted data including but limited to discharge disposition which impacts facility reimbursement and/or MS-DRG assignment.  Adheres to Standards of Ethical Coding (AHIMA).
Reviews medical records to determine accurate required abstracting elements (facility/client/payer specific elements) including appropriate discharge disposition
IP, OP Coding:  Reviews medical records for the determination of accurate assignment of all documented ICD-9-CM codes for diagnoses and procedures.
Abstracts accurate required data elements (facility/client specific elements) including appropriate discharge disposition.

3. Coding: Uses discretion and specialized coding training and experience to accurately assign ICD-9, CPT-4 codes to patient medical records. 

4. Abstracting:  Reviews medical records to determine accurate required abstracting elements (client specific elements) including appropriate discharge disposition. 

5. Coding Quality:  Demonstrates ability to achieve accuracy and consistency in the selection of principal and secondary diagnoses (including MCC & CC) and procedures.  Demonstrates ability to achieve accuracy and consistency in abstracting elements defined by SOW. 

6. CDI:  Identifies and communicates documentation improvement opportunities and coding issues (lacking documentation, physician queries, etc.) to appropriate personnel for follow-up and resolution.  

7. Professional Development:  Stays current with AHA Official Coding and Reporting Guidelines, CMS and other agency directives for ICD-9-CM and CPT coding.  Attends mandatory coding seminars on annual basis (IPPS and OPPS, ICD-9-CM and CPT updates) for inpatient and outpatient coding.  Quarterly review of AHA Coding Clinic.  Attends Quarterly Coding Updates and all coding conference calls 
  

SUPERVISORY RESPONSIBILITIES (if applicable)

This position carries out supervisory responsibilities in accordance with guidelines, policies and procedures and applicable laws. Supervisory responsibilities include interviewing, hiring, and training employees; planning, assigning and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems.

 

KNOWLEDGE, SKILLS, ABILITIES

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

• Ability to consistently code at 95% accuracy and quality while maintaining client specified production standards
• Must successfully pass coding test
• Knowledge of medical terminology, ICD-9-CM and CPT-4 codes
• Must be detail oriented and have the ability to work independently 
• Computer knowledge of MS Office
• Must display excellent interpersonal skills
• The coder should demonstrate initiative and discipline in time management and assignment completion 
• The coder must be able to work in a virtual setting under minimal supervision
• Intermediate knowledge of disease pathophysiology and drug utilization
• Intermediate knowledge of MSDRG classification and reimbursement structures
• Intermediate knowledge of APC, OCE, NCCI classification and reimbursement structures

 

Conifer requires its candidates, as applicable and as permitted by law, to