Health Information Auditor

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Job Summary: The Health Information Auditor ensures that coding specialists are well- trained and up-to-date on rapidly changing regulatory requirements affecting coding compliance and hospital reimbursement.

The auditor ensures coding data quality, accuracy and timeliness of submission to data repositories at the state, federal and hospital levels.

The auditor must maintain an up-to-date knowledge of all coding rules and guidelines and serves as a liaison with Patient Access and Patient Billing Services.

The auditor is responsible for ongoing and continuous monitoring of the quality of all coded data, performing monthly focused audits on all coders and ensuring that a 95% accuracy rate is maintained.

Minimum Education: High School Diploma or GED required.

Licensure, Registration and/or Certification: Certified Coding Specialist (CCS) required for facility coding or Certified Professional Coder (CPC) for professional coding.

Certified Professional Medical Auditor (CPMA) preferred.

Work Experience: 8 years related experience.

Knowledge, Skills and Abilities: Ability to utilize related software and computer/pc skills.

Advanced knowledge of coding.

Excellent interpersonal, written and oral skills.

Ability to analyze data and produce reports using MS office.

Essential Functions and Responsibilities: Audits randomly a % of each coders' work monthly, ensuring accuracy and compliance.

Audits focus DRGs as determined by outcomes to ensure compliance with regulatory standards.

Ensures timely submission of all coded accounts affecting hospital reimbursement.

Researches outstanding accounts and works to ensure completion.

Assigns and monitors Educode modules, ensuring that each coder completes assigned lessons.

Trains and orients new coders to the team.

Assists with physician queries for documentation.

Reviews pertinent reports such as monthly POA and produces individual and cumulative monthly quality reports.

Educates coders on LCD's, clinical coding guidelines and other regulatory guidelines.

Decision Making: Independent judgment in making decisions from many diversified alternatives that are subject to general review in final stages only.

Working Relationships: Coordinates activities of others (does not supervise).

Leads others in same work performed (does not supervise).

Has input on performance evaluations but does not prepare or give.

Works directly with patients and/or customers.

Works with internal/external customers.

Special Job Dimensions: None.

Supplemental Information: This document generally describes the essential functions of the job and the physical demands required to perform the job.

This compilation of essential functions and physical demands is not all inclusive nor does it prohibit the assignment of additional duties.