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Houston Methodist · 6 days ago

Coding Quality Auditor

Washington, United States

Full-time

Hybrid

Senior Level

5+ years exp

Houston Methodist is a healthcare organization seeking a Coding Quality Auditor to ensure accuracy in code assignment for outpatient and inpatient encounters. The role involves performing data quality reviews, maintaining compliance with guidelines, and participating in quality improvement projects.

Health CareMedical

Growth Opportunities

H1B Sponsor Likely

Responsibilities

Ensuring accuracy in code assignment of diagnosis and procedure to outpatient and/or inpatient encounters based upon documentation within the electronic medical record while maintaining compliance with established rules and regulatory body guidelines

Performing data quality review to ensure data integrity, coding accuracy, and revenue preservation

Participating in quality review and performance improvement projects throughout the department and/or facility

Interacting and communicating effectively with members of the coding team and HIM, physicians, CDMP nurses, IT, Quality Operations, Case Management, Patient Access and Business Office

Participating and providing good feedback during coding section meetings, coding education in-services, and coder/CDMP meetings

Responding promptly to internal and external customer coding/DRG requests

Identifying and anticipating customer requirements, expectations, and needs

Providing assistance to the leadership team or other coders with coding of the accounts or answering questions from other coders relating to coding and work flows

Initiating queries with physicians to obtain or clarify diagnoses and/or procedures as appropriate, utilizing the established physician query process

Providing assistance to Clinical Documentation Management Program (CDMP) with appropriate MS-DRG and APR-DRG assignment, sequencing of diagnoses and procedures, and coding and documentation training

Assisting with quality assurance (peer) reviews to ensure data integrity and accuracy of coding, identifying opportunities for improvements, and making recommendations for optimal enhancements

Assisting Case Management and Patient Access Departments in providing appropriate CPT codes for pre-admission and pre-certification requirements including the inpatient only process

Assisting in the development of documentation protocols for physicians

Representing the coding area in Hospital meeting/events when necessary (e.g., Performance Improvement Committees)

Maintaining and achieving the highest standards of coding quality by assigning accurate ICD-9-CM/ICD-10-CM/ICD-10-PCS and CPT codes utilizing an electronic encoder application in accordance with hospital policy and regulatory body guidelines

Performing accurate, optimal DRG and APC assignment, in accordance with nationally established rules and guidelines based upon documentation within the medical record

Reviewing discharge disposition entered by nursing and correcting if necessary in order to achieve the highest quality of entered data

Assigning and entering physician identification number and procedure date correctly in the medical record abstracting system

Reviewing medical record documentation and abstracting data into the encoder and Electronic Health Record (EHR) abstracting system to determine principal or final diagnosis, co-morbid conditions and complications, secondary conditions and procedures

Assisting with quality reviews of outpatient or inpatient accounts and/or training of new coders

Complying with the Standards of Ethical Coding as set forth by the American Health Information Management Association (AHIMA) and adhering to official guidelines

Aggregating data from reviews and compiling reports for HIM management

Utilizing time effectively

Consistently coding and abstracting at departmental standards of productivity while ensuring accuracy of coding

Ensuring work flows and worklists are reviewed or monitored in order to identify old uncoded accounts or problem accounts

Assisting in making sure coding bill hold goal is met

Maintaining coding timeframes within acceptable guidelines by ensuring all work items assigned to the coding queues and worklists are processed in a timely manner

Critically evaluating her or his own performance, accepting constructive criticism, and looking for ways to improve

Displaying initiative to improve relative to job function

Contributing ideas to help improve quality of coding data and abstracting data

Qualification

RHIT certificationRHIA certificationCCS certificationCPC certificationICD-10 codingCPT codingElectronic medical recordMedical terminologyCustomer service focusCommunication skillsTeam collaboration

Required

Associate's degree or higher in a Commission on Accreditation in Health Informatics and Information Management accredited program required or additional two years of experience (in addition to the minimum experience requirements listed below) required in lieu of degree

Five years of coding experience relevant to the area auditing (e.g., inpatient, outpatient, professional fee)

For inpatient/outpatient coding: RHIT, RHIA, or CCS certification from AHIMA is required

For professional fee coding: CPC from AAPC is required

Demonstrates the skills and competencies necessary to safely perform the assigned job, determined through on-going skills, competency assessments, and performance evaluations

Sufficient proficiency in speaking, reading, and writing the English language necessary to perform the essential functions of this job, especially with regard to activities impacting patient or employee safety or security

Ability to effectively communicate with patients, physicians, family members and co-workers in a manner consistent with a customer service focus and application of positive language principles

Knowledge of an electronic medical record and imaging systems

Working knowledge of medical terminology, anatomy and physiology

Proficiency with electronic encoder application

Preferred

AHIMA designated ICD-10 Approved Trainer

Company

Houston Methodist

Glassdoor4.3

Houston Methodist is one of the nation’s leading health systems and academic medical centers.

Founded in 1919

Houston, Texas, USA

10001+ employees

http://www.houstonmethodist.org/

H1B Sponsorship

Houston Methodist has a track record of offering H1B sponsorships. Please note that this does not guarantee sponsorship for this specific role. Below presents additional info for your reference. (Data Powered by US Department of Labor)

Distribution of Different Job Fields Receiving Sponsorship

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Trends of Total Sponsorships

2025 (15)

2024 (11)

2023 (14)

2022 (12)

2021 (10)

2020 (10)