Hospital Coding Auditor
On-siteBrentwood, Tennessee, United States
Job Summary
Conduct comprehensive record reviews to identify documentation gaps and best-practice process improvement opportunities. Perform high-level secondary case reviews to ensure accurate, complete, and compliant provider documentation aligned with ICD-10-CM/PCS, MS-DRG/APR-DRG, and payer guidelines. Analyze audit findings, evaluate trends and risks, and prepare detailed reports for internal and external stakeholders. Produce and update guidelines, processes, and documentation standards to support consistent audit practices. Engage with client utilization management teams to provide feedback and support improvement initiatives. Deliver education on clinical concepts and documentation requirements to clients, CDI specialists, and clinical staff. Utilize authoritative references, CMS/CPT guidelines, and statistical analyses to validate findings and communicate outcomes effectively. Manage workload and prioritize tasks to ensure timely, high-quality audit completion in accordance with policies and financial regulations.
Required Qualifications
- High School Diploma
- 3+ years MS DRG/APR DRG experience
- Epic experience
- One of the following Coding Certifications required: RHIA, RHIT, CCS, CIC, CCDS, CDIP or CPC
- Expert knowledge of ICD -10-CM coding including but not limited to; expert knowledge of principal diagnosis selection, complications/comorbidities (CCs) and major complications/comorbidities (MCCs), and conditions that impact severity of illness (SOI) and risk of mortality (ROM)
- Expert knowledge of ICD-10-PCS coding methodologies, code sequencing, and discharge disposition in accordance with CMS requirements, Official Guidelines for Coding and Reporting, and Coding Clinic guidance
- Ability to apply clinical review judgment to make clinical determinations
- Proficient in computer skills and typing, i.e., Microsoft Windows, Outlook, Excel, Word, PowerPoint, Internet browsers and virtual meeting tools i.e., Microsoft Teams, Zoom, etc.
- Strong written and oral communication skills
- Demonstrated analytical approach to problem solving
Desired Qualifications
- RN license
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