Revenue Integrity Coding AuditorLocation: Remote/Hybrid - Open to All States
Travel Requirement: Must be willing to travel to Arkansas for orientation (travel expenses likely self-funded). Suggested to stay close to the orientation location.
Salary: $75,000 - $90,000 Base
Position SummaryWe are seeking a highly skilled and experienced Revenue Integrity Coding Auditor to join our dynamic team. The ideal candidate will possess a Certified Coding Specialist (CCS) or Certified Professional Coder (CPC) certification and have a minimum of 3 years of Inpatient and/or Outpatient coding experience. This role is crucial in ensuring accurate coding, MS-DRG assignment, and compliance within our healthcare organization.
Work Schedule

• Full-time: 40 hours per week
• Monday - Friday

Primary DutiesReview Activities:

• Conduct reviews of Clinical Documentation Improvement (CDI) mismatches.
• Evaluate responses to late query submissions.
• Assess Besler quality recommendations.
• Examine coding issues related to medical necessity and other concerns.
• Investigate MS-DRG denials.
• Conduct coding compliance research.
• Perform RVU analysis.
• Review high-risk cases (e.g., Impella, TCAR, Aveir DR).
• Handle rebill requests.
• Address discharge not final billed (DNFB) reports.
• Provide continued support for charge review.

Collaboration:

• Work closely with providers, clinical, coding, and CDI team members.
• Respond to coding questions and collaborate with the CDI QA team on DRG reconciliation.
• Collaborate with the Director of HIM/Coding/Billing on coding quality and education recommendations.

Auditing and Reporting:

• Perform random and focused medical records reviews for accurate coding and MS-DRG assignment.
• Summarize audit findings and provide feedback to the Director.
• Maintain detailed records of audits, results, recommendations, and follow-up actions.

Training and Education:

• Assist in the training of new coding team members.
• Contribute to educational activities for all coding team members.
• Educate providers on coding updates, documentation standards, and summary reviews.

External Audits:

• Review and respond to third-party coding audits/reviews.

BenefitsThe successful candidate will help enhance the organization's efficiency by:

• Increasing efficiency in coding processes.
• Reducing Days Not Final Billed (DNFB).
• Decreasing Accounts Receivable (AR) days.
• Providing research support for coding and RVU-related questions.
• Improving cash flow.

Note: This job description is subject to change as the needs of the organization evolve.
Qualifications/Specifications

• Education: High School diploma or equivalent required.
• Licensure/Certification: Certified Coding Specialist (CCS) or Certified Professional Coder (CPC) certification required.
• Experience: Minimum of three years of experience in medical coding with ICD-10 and CPT coding systems required. Detail-oriented and experienced coding professional with a passion for ensuring accuracy and compliance.