Hospital Coding Auditor

Ardent Health is a leading provider of healthcare in growing mid-sized urban communities across the U.S. With a focus on people and investments in innovative services and technologies, Ardent is passionate about making healthcare better and easier to access. Through its subsidiaries, Ardent delivers care through a system of 30 acute care hospitals, 24,000+ team members and more than 280 sites of care with over 1,800 affiliated providers across six states.

POSITION SUMMARY

The Hospital Coding Auditor performs in depth audits of hospital (inpatient and outpatient) claims for compliance with federal and state coding regulations and guidelines.

• Perform in-depth quality assurance audits of hospital (inpatient and outpatient) claims to support ICD-10-CM and ICD-10 PCS codes and MS-DRG and APR-DRG assignments and/or CPT-4 and APC assignments, based on clinical documentation
• Audit patient records, reviewing diagnosis and procedures for coding compliance with local, state, federal coding regulations and guidelines
• Identify occurrences of "over" or "under" coding of patient records
• Identify potential documentation issues
• Prepare detailed reports on audit findings
• Present audit findings, education, and trends to physicians, coders, and/or other facility professionals on a monthly, quarterly and/or yearly basis
• Serve as an expert in Outpatient Prospective Payment System and/or Inpatient Prospective Payment System.
• Create consistency and efficiency in outpatient or inpatient claims processing and data collection to optimize APC, ASC or DRG reimbursement.
• Assists management with training new Coders or Clinical DRG Auditors to include daily monitoring, mentoring, feedback and education.

Education & Experience:

• High school diploma.
• Associate's degree, preferred.
• Active RN license, preferred.
• One of the following coding certifications required: RHIA, RHIT, CCS, CIC, CCDS, CDIP or CPC.
• 3+ years of MS DRG/APR DRG coding or auditing experience with expert knowledge of ICD-10 Official Coding Guidelines and DRG reimbursement methodologies.
• Epic experience required.
• Clinical experience in an inpatient hospital setting, preferred.

Knowledge, Skills & Abilities:

• Expert knowledge of ICD -10-CM coding including but not limited to; expert knowledge of principal diagnosis selection, complications/comorbidities (CCs) and major complications/comorbidities (MCCs), and conditions that impact severity of illness (SOI) and risk of mortality (ROM)
• Expert knowledge of ICD-10-PCS coding methodologies, code sequencing, and discharge disposition in accordance with CMS requirements, Official Guidelines for Coding and Reporting, and Coding Clinic guidance
• Ability to apply clinical review judgment to make clinical determinations
• Proficiency in computer skills and typing, i.e., Microsoft Windows, Outlook, Excel, Word, PowerPoint, Internet browsers and in virtual meeting tools i.e., Microsoft Teams, Zoom, etc.

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