The Revenue Integrity Coding Auditor will be responsible for the following key areas, including but not limited to:
Review 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 such as Impella, TCAR, Aveir DR.
- Handle Rebill Requests.
- Address Discharge Not Final Billed 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 CDI QA team on DRG reconciliation.
- Collaborate with the Director of HIM/Coding/Billing regarding coding quality and education recommendations.
Auditing and Reporting:
- Perform random and focus-selected medical records review for accurate coding and MS-DRG assignment.
- Summarize audit findings and provide feedback to the Director.
- Keep 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.
- Provide education to providers on coding updates, documentation standards, and summary reviews.
External Audits:
- Review and respond to third-party coding audits/reviews.
Benefits:
The successful candidate will contribute to the organization's overall efficiency, resulting in benefits such as:
- Increased efficiency in coding processes.
- Lowering 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.*
