Coding Auditor-Inpatient (Potential Remote in DFW Area Only)
Discovering a professional or business career in health care where the opportunities, challenges and rewards match your desire to make a difference — This is Real! Seek joy with us here at JPS Health Network and own it like nowhere else.
Req #:8562 Category:BUSINESS/PROFESSIONAL Division:Quality Employment Type:Full Time Shift:Day Hours:Mon-Fri 8A-4:30P Compensation Type:Salaried Facility:John Peter Smith Hospital Location:1500 S. Main Street, Fort Worth, TX
Description: Under direction of the Coding Manager, the Inpatient Coding Auditor will conduct coding quality reviews, pre-bill audits, and coder education to ensure compliance with American Hospital Association coding guidelines, Centers for Medicare /Office of Inspector General requirements, and all payer requirements for inpatient coding. (Potential Remote) Typical Duties:
Performs coding quality reviews on inpatient records to validate accuracy and completeness of International Classification of Disease (ICD) diagnosis and procedure codes and Medicare (MS) and All Patient Refined (APR) Diagnosis Related Group (DRG) assignment appropriateness. Additionally, validates the selection of attending physician and surgeon and the assignment of present on admission (POA) diagnoses.
Reviews results of external audits with Coding Manager and individual coders. Works with the Coding Manager to reconcile coding audits and resolve coding issues. Provides focused coding monitoring and feedback based on findings.
Is the liaison between the Clinical Documentation Improvement (CDI) nurses and coders for any conflicts between assignment of principle diagnosis, complications and comorbidities and major complications and comorbidities that impact the final DRG. Will work with the CDI nurses in developing physician documentation improvement initiatives. In addition, will be liaison between Patient Accounting, HIM, Compliance and Care Management for denials from payors including the appeals process for HIM related denials.
Serves as an inpatient coding resource for the Health Information Management Department, Physicians and Practitioners to obtain information on accurate and ethical coding documentation standards guidelines and regulatory requirements.
Provides or arranges for training of coding and reimbursement specialists in the use of coding guidelines and practices, proper documentation techniques, medical terminology and disease processes, appropriate to the job description and function as it relates to the MS-DRG, the APR-DRG and other clinical data management quality factors.
Develops reports and collects and prepares data for studies involving inpatient stays for clinical evaluation purposes and financial impact and profitability, including rebill auditing and auditing of OIG targeted DRGs.
Exhibits excellent written and verbal communication skills.
Demonstrates critical thinking skills and the ability to make decisions regarding coding standards independently.
Performs other job related duties as assigned.
Required Education and Experience:
Associate Degree or Bachelor’s degree in Health Information Management (HIM).
Minimum of 5 years’ experience in inpatient coding.
Preferred Education and Experience:
Experience coding Level I trauma charts preferred.
American Health Information Management Association (AHIMA) granted: Registered Health Information Administrator (RHIA) or Registered Health Information Technologist (RHIT).
Certified Coding Specialist (CCS) credentials.
JPS Health Network is a $950 million, tax-supported health care system for Tarrant County in North Texas. Licensed for 578 beds, the network includes an acute care hospital and more than 40 community-based clinics, including 19 school-based clinics. John Peter Smith Hospital is home to Tarrant County’s first and only Level 1 Trauma Center, its only psychiatric emergency services site and has the largest hospital-based family medicine residency program in the nation. Our network employs more than 6,500 people.
Acclaim is our multispecialty medical practice group. Acclaim has over 300 providers serving the JPS Health Network in specialties ranging from primary care to general surgery and trauma. The Acclaim group has been formed around a common set of incentives and expectations supporting the operational, financial and clinical performance outcomes of the network. Our goal is to provide high quality, compassionate clinical care for every patient, every time.