R1 RCM · 2 days ago
Coding Denial Auditor
United States
Full-time
Remote
Senior Level
$26.26/hr - $38.50/hr
7+ years exp
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Responsibilities
Audits records as defined in the coding quality review plan. Review cases flagged by the coding quality software on a daily basis for multiple hospitals, including validating the completeness of documentation, identifying diagnoses and procedures that have been missed, proposing physician queries, and ensuring the accuracy of diagnoses, procedures, POA, discharge disposition and DRG assignment
Perform retrospective coding quality reviews as requested
Follows, and maintains up-to-date knowledge of, industry coding and documentation guidelines (e.g., Official ICD-10 Coding and Billing Guidelines, Coding Clinic advice, R1 and Ascension coding policies and procedures, and AHIMA/ACDIS Query Guidelines) so as to maintain system-wide coding consistency and remain in compliance with governmental and other regulatory guidelines
Communicates audit findings with coders in a timely manner and supports the teams in effectively and efficiently addressing and resolving local coding issues
Maintains both a high productivity rate and a high accuracy rate in accordance with established auditing standards
Serves as an inpatient coding expert & resource for the coding teams and other departments
Works with the Regional Manager to identify areas of educational need based on audit results
Reports to, and works with, the Regional Manager to identify improvements in the audit software tool, workflow processes and flag management; and assist with evaluation and testing of audit applications and updates as needed
Work with the hospital’s CDI team to address and resolve documentation issues
Assists with compilation, generation and analysis of data for results reporting and performance Improvement initiatives
Contributes to the reduction of the hospital's and Company’s coding compliance risks and contributes to the Company’s revenue enhancement goals
Maintains an open dialogue and a good working relationship with team members in order to advance the mission and objectives of the hospitals and R1
Assists with training of new auditors. Assists with other audits and duties as requested
Qualification
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Required
Bachelor's or Associates Degree with CCS credential is required
A minimum of seven (7) years of hospital inpatient coding experience is required
Extensive knowledge of ICD-10-CM/PCS classification system and MS-DRG and APR-DRG methodologies is required
In-depth knowledge of medical terminology, human anatomy/physiology, pharmacology, and pathology is required
Expert and up-to-date knowledge of industry Official Coding and Reporting Guidelines along with CMS and other agency directives for ICD-10 coding
Must have proficient MS Office computer skills, specifically in Excel and knowledge of various coding software/platforms and EMRs
Must be detail-oriented and have the ability to work independently and maintain a high productivity rate and coding accuracy rate
Ability to interact with other employees through effective communication Must be a self-starter
Preferred
Two (2) years of inpatient coding audit experience is preferred
Experience in a large (> 500 beds) hospital or multi-hospital health system is preferred
Training in hospital Clinical Documentation Improvement is preferred
Experience as a Coding Consultant with a consulting firm is preferred
Benefits
Competitive benefits package
Company
R1 RCM
R1 RCM serves as a revenue cycle management partner for hospitals and healthcare systems regardless of the payment models.
10,001+ employees
Funding
Current Stage
Public CompanyTotal Funding
$200MKey Investors
Intermountain Healthcare
2024-08-01Private Equity· undefined
2024-08-01Acquired· undefined
2018-03-21IPO· undefined
Leadership Team
Andrew Holmes
VP of Strategic Initiatives, Chief of Staff to CEO
Lee Rivas
Chief Executive Officer
Recent News
2024-11-20
Company data provided by crunchbase
