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Children's Hospital of Philadelphia · 2 months ago

Coding Auditor Specialist

Philadelphia, PA

Full-time

Onsite

Senior Level

$82K/yr - $104K/yr

5+ years exp

Children’s Hospital of Philadelphia (CHOP) is dedicated to advancing pediatric care and fostering a diverse community of Breakthrough Makers. The Coding Auditor Specialist plays a crucial role in ensuring the accuracy and integrity of coding processes by reviewing coded accounts, conducting audits, and providing education to improve documentation and compliance.

Child CareHealth CareHospitalMedicalNon Profit

Growth Opportunities

Responsibilities

Perform pre-bill reviews of coded accounts to validate code assignment and identify missed opportunities or inaccuracies

Conduct retrospective reviews of high-risk coding areas and regularly scheduled audits for compliance with: Official Coding Guidelines, CHOP internal guidelines, AHA Coding Clinic for ICD-10 HCPCS, CPT-4, and AMA CPT Assistant

Audit records to identify documentation improvement opportunities related to:

Severity of Illness (SOI)

Risk of Mortality (ROM)

APR-DRG and/or MS-DRG

APC

ICD-10-CM/PCS

CPT-4 and HCPCS

Assist in the review of Hospital-Acquired Conditions (HACs) and other quality indicators for appropriateness

Identify anomalous coding or query practices and escalate to leadership

Serve as a subject matter expert for coding practices and guidelines

Provide education to physicians, clinical documentation specialists, and coders based on audit findings and trends

Recommend and deliver targeted education based on identified coding or documentation trends

Stay current with all coding, documentation, and query guidelines and regulatory changes

Organize and report audit findings regularly to leadership

Identify and communicate coding issues and trends to leadership

Recommend areas for education and process improvement

Track audit outcomes and maintain documentation for compliance and quality assurance

Collaborate with CDI specialists, providers, and billing teams to resolve discrepancies and improve documentation

Adhere to all internal policies, procedures, and guidelines of the Coding and Clinical Documentation Integrity department

Set goals and prioritize work using available resources efficiently and effectively

Participate in Quality Improvement initiatives and represent the Coding team on relevant committees

Develop and maintain standardized orientation training for coding and documentation

Track training completion metrics and escalate unmet training needs

Create enterprise documentation tip-sheets in collaboration with other stakeholders

Track recurring deficiencies and recommend EMR template updates

Qualification

ICD-10-CMICD-10-PCSAPR-DRGMS-DRGCoding AuditsEncoder softwareElectronic Health RecordsMicrosoft OfficeHealth Information ManagementRevenue cycle functionsAnalytical skillsIndependenceData analysisComplex information conveyanceCommunication skillsInterpersonal skillsCritical thinkingConfidentiality

Required

Associate's Degree Health Information Management or related field

At least five (5) years inpatient and outpatient coding experience

Ability to lead a team for projects

Advanced knowledge of complex surgical coding

Advanced knowledge of ICD-10-CM and ICD-10-PCS

Advance knowledge of the APR-DRG system

Knowledge of the MS-DRG system

Knowledge the revenue cycle functions

Experience with encoder software such as 3M CRS and/or 3M 360 CAC

Familiarity with electronic health records (EHR), preferably Epic experience

Proficiency with Microsoft Office products such as Microsoft Office and Excel

Excellent verbal and written communications skills

Excellent interpersonal skills

Strong critical thinking / problem-solving skills

Strong analytical skills

Ability to maintain confidentiality and professionalism

Ability to work independently with minimal supervision

Ability to gather, analyze and make recommendations/decisions based on data

Ability to convey complex or technical information in an easy-to-understand manner

Registered Health Information Technician (RHIT) - American Health Information Management Association - upon hire or Registered Health Information Administrator (RHIA) - American Health Information Management Association - upon hire

Preferred

Bachelor's Degree Health Information Management or related field

At least two (2) years experience performing coding audits

Certified Coding Specialist (CCS) - American Health Information Management Association - upon hire

Certified in Healthcare Privacy and Security (CHPS) - American Health Information Management Association - upon hire

Company

Children's Hospital of Philadelphia

Glassdoor4.0

Since its start in 1855 as the nation's first hospital devoted exclusively to caring for children, The Children's Hospital of Philadelphia has been the birthplace for many dramatic firsts in pediatric medicine.

Founded in 1855

Philadelphia, Pennsylvania, USA

10001+ employees