Description

This position audits the accuracy and completeness of diagnosis and procedure coding, DRG assignment, and abstracted data to support that appropriate reimbursement and clinical severity is captured for the level of service rendered. Provides ongoing education to coders, physicians, and other clinical staff. The incumbent serves in an advisory and educator role for coding and regulatory compliance.

Responsibilities

Essential Functions

• Reviews inpatient medical records post-discharge and pre-bill, audits the accuracy and completeness of diagnoses, procedure coding, abstracted data and DRG assignment.
• Reviews non-CC/MCC records to determine if the record was coded correctly or if additional codes may be reported by obtaining documentation supported by clinical indicators and treatment.
• Develops and coordinates coding education and formal training programs.
• Improves documentation by participating in the CDI query audit process.
• Works effectively with the Coding Manager to improve Inpatient coding accuracy.

Knowledge / Skills / Abilities

• Possesses knowledge of DRG and grouping methodologies, in particular what diagnoses and procedures impact DRG assignment.
• Possess strong knowledge of the diagnosis and procedure codes.
• Excellent interpersonal skills to develop relationships necessary to facilitate and educate.
• Excellent prioritization and organizational skills

Requirements

Qualifications Required

• Bachelor's degree or a minimum of six years experience of HIM Management.
• Four years of experience with coding ICD-10.
• Clinical Coding Specialist (CCS) certification.
  
  

One of the following:

• Current CCDS Certification with The Association of Clinical Documentation Improvement Specialists (ACDIS).
• Current Certified Documentation Improvement Practitioner (CDIP) through the AHIMA or obtain within 6 months of hire

* Additional license requirements as determined by the hiring department.

Qualifications (Preferred)

• RHIA/RHIT