Job Description

Coding Quality Auditor - Remote at Conifer Revenue Cycle Solutions summary:

The Coding Quality Auditor performs detailed audits of inpatient and outpatient medical records to ensure coding accuracy and compliance with official guidelines. They consult healthcare facility staff on coding best practices, validate data elements critical for reimbursement, and identify documentation improvement opportunities. The role requires strong knowledge of ICD, CPT codes, medical terminology, and healthcare reimbursement methodologies, working independently in a remote or onsite setting.

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.

• Consulting : Consults facility leaders and staff on best practices, methodology, and tools for accurately coding.
• 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.
• Coding : Uses discretion and specialized coding training and experience to accurately assign ICD-9, CPT-4 codes to patient medical records.
• Abstracting : Reviews medical records to determine accurate required abstracting elements (client specific elements) including appropriate discharge disposition.
• 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.
• CDI : Identifies and communicates documentation improvement opportunities and coding issues (lacking documentation, physician queries, etc.) to appropriate personnel for follow-up and resolution.
• 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

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 accommodations 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 obtain and provide confirmation of all required vaccinations and screenings prior to the start of employment. This may include, but is not limited to, the COVID-19 vaccination, influenza vaccination, and/or any future required vaccines and screenings.

EDUCATION / EXPERIENCE

• Associates degree in relevant field preferred or combination of equivalent of education and experience
• Three years coding experience including hospital and consulting background

CERTIFICATES, LICENSES, REGISTRATIONS

• AHIMA Credentials, and or AAPC

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Duties may require bending, twisting and lifting of materials up to 25 lbs.
• Duties may require driving an automobile to off- site locations.
• Duties may require travel via, plane, care, train, bus, and taxi-cab.
• Ability to sit for extended periods of time.
• Must be able to efficiently use computer keyboard and mouse to perform coding assignments.

WORK ENVIRONMENT

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Floats between clients as requested.
• Capacity to work independently in a virtual office setting or at hospital setting if required to travel for assignment.

OTHER

• Regular travel may be required

As a part of the Tenet and Catholic Health Initiatives family, Conifer Health brings 30 years of healthcare industry expertise to clients in more than 135 local regions nationwide. We help our clients strengthen their financial and clinical performance, serve their communities and succeed at the business of healthcare. Conifer Health helps organizations transition from volume to value-based care, enhance the consumer and patient healthcare experience and improve quality, cost and access to healthcare. Are you ready to be part of our solutions? Welcome to the company that gives you the resources and incentives to redefine healthcare services, with a competitive benefits package and leadership to take your career to the next step!

Compensation and Benefit Information

Compensation

• Pay: $30.85 - $46.28 per hour. Compensation depends on location, qualifications, and experience.
• Position may be eligible for a signing bonus for qualified new hires, subject to employment status.
• Conifer observed holidays receive time and a half.

Benefits

Conifer offers the following benefits, subject to employment status:

• Medical, dental, vision, disability, and life insurance
• Paid time off (vacation & sick leave) – min of 12 days per year, accrue at a rate of approximately 1.84 hours per 40 hours worked.
• 401k with up to 6% employer match
• 10 paid holidays per year
• Health savings accounts, healthcare & dependent flexible spending accounts
• Employee Assistance program, Employee discount program
• Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, AD&D, auto & home insurance.
• For Colorado employees, Conifer offers paid leave in accordance with Colorado’s Healthy Families and Workplaces Act.

Employment practices will not be influenced or affected by an applicant’s or employee’s race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship.

Keywords:

medical coding, coding audit, ICD coding, CPT coding, health information, data validation, clinical documentation, reimbursement validation, healthcare compliance, remote coding

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