Health Information Management Inpatient Coding Auditor Senior

Role Description

This expert level inpatient senior coding analyst is responsible for coder training, work queue management, performing second-level coding reviews utilizing auditing software, and documenting findings to improve MCC/CC, HAC/PSI, HCC, and Quality Indicator validation.

• Conducts review and audit of discharged inpatient records (prebill and retrospective reviews) to validate the coding/DRG assignment according to official coding guidelines as supported by the clinical documentation in the record.
• Monitors work queues daily to identify, prioritize, and assign accounts that need to be coded based on department-specific guidelines and within designated timelines in coordination with leadership.
• Mentors and trains coders on application of correct ICD-CD and ICD PCS guidelines.
• Coordinates and identifies provider documentation queries for the Clinical Documentation Integrity team to send to clinical providers.
• Consults, provides professional expertise to, and collaborates with clinical documentation specialists on coding and documentation practices and standards.
• Assists with and develops educational programs for coding staff, clinical documentation staff, and medical staff including yearly coding/DRG updates.
• Applies ICD and ICD-PCS codes including major traumas and Neonatal Intensive Care Unit (NICU) records based on review of clinical documentation.
• Identifies and assists management with the resolution of coding issues, process improvement, and system testing for HIM applications.
• Interacts with other departments to resolve coding issues and assists with coding and clinical validation denials.
• Participates in on-site, remote, and/or external training workshops and training.
• Performs other duties as assigned.

Qualifications

• Associate's degree or Coding Certificate through approved American Health Information Management (AHIMA) or other coding certification program.
• 4 years of experience in inpatient coding and abstracting with healthcare billing process experience in an acute care setting.
• Demonstrated high coding accuracy and productivity.

Requirements

• Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), Certified Coding Specialist (CCS), Certified Inpatient Coder (CIC) or other approved coding credential.
• Knowledge of electronic medical records and 3M or Encoder System.
• EPIC health information system experience (preferred).
• Strong knowledge of medical terminology and basic anatomy and physiology, pathophysiology, and pharmacology with the ability to apply this knowledge to the coding process.
• Knowledge of MS DRG prospective payment system and severity systems.
• Knowledge of Clinical Documentation Improvement principles, quality indicators, formal and informal coding audit process.
• Ability to work effectively, independently and manage multiple demands consistently.
• Proficient computer skills (spreadsheets and database).
• Ability to apply broad guidelines to specific coding situations, independently utilizing discretion and a significant level of analytic ability (preferred).

Benefits

• Comprehensive health insurance
• 401(k) with company match

Company Description

Prisma Health is the largest not-for-profit health organization in South Carolina, serving more than 1.2 million patients annually. Our 32,000 team members are dedicated to supporting the health and well-being of you and your family.