Description

Jackson Memorial Hospital

Health Information Management Dept.

Days, FT

Position Summary:
The HIM Coding/Compliance Auditor 2 analyzes abstracted, coded data for the purpose of ensuring coding accuracy. Serves as a resource for expert knowledge in coding and documentation requirements. Performs coding audits on inpatient and outpatients coders, reviews SMART edits, external coding audits, claim denials and audits from insurance companies, as well as, any other coding audits. Works very closely with the CDI Department. Must be an expert on ICD-9 and CPT Coding systems. Must have ICD-10 knowledge. This position acts in a confidential capacity to assist or aid department management. The position will have a significant role in processing confidential information.

Duties & Responsibilities:
Performs Internal Coding Audits on inpatient and outpatient coders providing feedback and re-training as required. Reviews findings from External Coding Audits for validity of DRG assignment and provide responses if there is a disagreement. Discusses findings and any discrepancies in coding accuracy with external vendor, citing Coding Guidelines and coding Clinics. Perform SMART edit reviews and educate the internal coders on their errors. Review and respond to email requests from the CBO for DRG validation, missing procedure codes, Discharge Status discrepancies and Present on Admission assignments. Provide responses to inquires from insurance companies regarding accuracy in codes used by the facility. Reviews claim denials/audits from insurance companies. Provide education and guidance to the CDI team and the inpatient and outpatient coding staff, reviewing diagnoses and/or procedures that require clarifications. Annual coding updates are reviewed at these sessions, as well as, Coding Guidelines and Coding Clinics. Works with the Rehabilitation Teams from Jackson Main and Jackson North reviewing and advising on concurrent coding worksheets. Works with the CBO and the Revenue Cycle Team providing DRG validation and correcting accounts with missing or incorrect coding. Provides feedback to the coder involved in each case. Completes entering coding for in-house patients as per CBO request. Works closely with the CDI Team including concurrent DRG validation; provides assistance with assigning DRG's to in-house patients and provides individual guidance and education in applying Coding Guidelines. Works with different services educating them on appropriate documentation to support the severity of the patient's condition. Neonatology Team, Burn Center, etc. Demonstrates behaviors of service excellence and CARE values (Compassion, Accountability, Respect and Expertise). Performs all other related job duties as assigned.

Qualifications

Experience:
Generally requires 5 to 7 years of related experience.

Education:
High school diploma is required. Bachelor's degree in related field is strongly preferred.

License Certification:
Valid license or certification is required as needed, based on the job or specialty.

Knowledge Skill Abilities:
Ability to analyze, organize and prioritize work accurately while meeting multiple deadlines. Ability to communicate effectively in both oral and written form. Ability to handle difficult and stressful situations with critical thinking and professional composure. Ability to understand and follow instructions. Ability to exercise sound and independent judgment. Knowledge and skill in use of job appropriate technology and software applications.

Physical Demands:
Job function is sedentary in nature and requires sitting for extended periods of time. Function may require frequent standing or walking. Must be able to lift or carry objects weighing up to 20 pounds. Jobs in this group are required to have close visual acuity to perform activities such as: extended use of computers, preparing and analyzing data and analytics, and other components of a typical office environment. Additional information and provision requests for reasonable accommodation will be provided by the home unit/department in collaboration with the Reasonable Accommodations Committee (RAC).

Work Environment:
Jobs in this group are required to function in a fast paced environment with occasional high pressure or emergent and stressful situations. Frequent interaction with a diverse population including team members, providers, patients, insurance companies and other members of the public. Function is subject to inside environmental conditions, with occasional outdoor exposures. Possible exposure to various environments such as: communicable diseases, toxic substances, medicinal preparations and other conditions common to a hospital and medical office environment. May wear Personal Protective Equipment (PPE) such as gloves or a mask when exposed to hospital environment outside of office. Reasonable accommodations can be made to enable people with disabilities to perform the described essential functions. Additional information and provision requests for reasonable accommodation will be provided by the home unit/department in collaboration with the Reasonable Accommodations Committee (RAC).