Coder Compliance Auditor

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Job ID: 58896
Area of Interest: Professionals
Location: Baltimore, MD US
Hours of Work: M-F, 8am-4pm
Job Facility: University of Maryland Medical Center
Employment Type: Full Time
Shift: DAY
What You Will Do:

**Must have RHIA, RHIT, CCS or CCS-P certification

General Summary

Under general supervision, reviews all inpatient and outpatient charts for coding of diagnoses and procedures according to ICD-9-CM and CPT-4 principles and hospital guidelines. Develops, implements and monitors policies and procedures to ensure data quality and efficient and effective operation of coding function. Maintains compliance with Federal and state guidelines in relation to reimbursement, research and statistics. Performs data collection for quality following the official guidelines and CMS requirements.Enters all coding and data collection into the computer. Assists in conducting in-service training and training new employees. Performs responsibilities of DRG Specialist. Ensures effective training of coding staff.

Principal Responsibilities and Tasks
The following statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all job duties performed by personnel so classified.

  • Supervises assigned coding staff.
  • Performs annual employee performance reviews and counsels employees on performance issues, as necessary.
  • Assists Sr. Coding manager in establishing work performance and quality standards, implements and monitors same.
  • Establishes goals and objectives for coding and identifies goals to support the department’s objectives. Establishes target dates and/or milestones to attain goals; ensures goals are attained according to schedule and investigates problems/issues if they occur.
  • Establishes production standards for coding and abstracting functions.
  • Ensures coding staff attain their daily coding production standards and that they submit accurate daily work production records to management
  • Monitors the production of the staff and identifies and investigates production trends.
  • Captures and records production & auditing statistics on coding staff on a monthly basis.
  • Performs Coder Compliance Auditor responsibilities for sections in the central Medical Records department and/or satellites.
  • Review inpatient and outpatient records for accuracy and data quality.
  • Assist in training new technicians and coding staff.  Provides coding instruction as needed.
  • Provides feedback to manager and Lead Coder Compliance Auditor regarding work performance of DRG Specialists.
  • Gathers and records data used individual team and feedback performance reporting.  Responsible for the integrity of recorded information.
  • Actively and continuously improves work processes. Uses continuous improvement tools and methods to improve individual and team performance. Based improvements on customer requirements, data, root-cause analysis and outcomes. Provides guidance and instruction to employees where skills are in need of improvement, as needed.
  • Compiles and  analyzes administrative and health statistics for reimbursement, quality assurance
  • Using manual or computerized methods as appropriate. Complies and generates Core reports and
  • Pull list.
  • Codes diagnoses and procedures of discharged patient records using either the International Classification of Diseases, 9th Edition, Clinical Modification (ICD-9-CM), the Current Procedural Terminology (CPT-4) or ICD-0 or other relevant approved classification system, maintaining a 95% accuracy rate. Enters assigned codes into computer abstracting system.
  • Assists in assigning and verifying All Patient Refined Diagnosis Related Group (APR-DRG) assignments using computerized code book software.
  • Abstracts data from the medical record through intensive medical record review and enters information into  computer abstracting system for billing/reimbursement purposes and compilation of administrative and clinical statistics.
  • Completes the automated Medical Record Abstract form for Health Services Cost Review Commission (HSCRC) reporting and the Medical Assistance 3808 Form.
  • Maintains accurate physician information, diagnostic and procedural codes for research purposes
  • Locates additional on-live reports.
  • Contacts nursing, house, and medical staff to clarify questions concerning documentation in patient records to ensure accuracy and consistency of coding, abstracting or other purpose.
  • Assures data quality through accuracy, consistency and completeness of coding and abstracting functions. Assists in the quality monitoring of abstract data elements. Verifies accuracy of all data in the case mix abstract system for both inpatient and outpatient.
  • Maintains accurate and up-to-date coding manuals which includes all UMMS coding guidelines and abstracting manuals. 
  • Continuously develops and enhances skills in areas such as service quality improvement, customer service and interpersonal skills, Participates in UMMS educational opportunities and departmental staff meetings.
  • Maintains current credentials as an Accredited Medical Records Technician and Certified Coding Specialist by attending appropriate continuing education courses.
  • Communicates effectively with supporting staff and immediate supervisor. Provides information regarding work progress, actions and issues in a timely and effective manner.

What You Need to Be Successful:

Education & Experience

  • Associate’s degree in Health Information Technology or an Independent Study Program in Health Information Technology (RHIT/RHIA) from an accredited school of health information/health information administration required OR an equivalent combination of education and experience may be considered.
  • Current accreditation by the American Health Information Management Association,  R.H.I.T. or R.H.I.A. or  CCS, or CCS-P  required.
  • Minimum of three (3) years ICD-9-CM and CPT coding and abstracting experience in a health information department is required.
  • Minimum three (3) years experience with APR-DRG’s or MS-DRG’s and the understanding of APG’s is highly beneficial.
  • Experience in auditing inpatient highly preferred. Supervisory experience preferred.

Knowledge, Skills & Abilities

  • Knowledge of health information practices, state and federal laws relating to release of medical information, ICD-9-CM and CPT coding systems, medical terminology to understand diagnoses and procedures, and the content and organization of a medical record. 
  • Knowledge of ICD-10-CM & ICD-10-PCS preferred.
  • Knowledge of anatomy, physiology and disease process to understand and interpret diagnoses and procedures contained within, discharge summaries, operative and laboratory reports and related medical documents.
  • Knowledge of keyboard, personal computer and other routine office equipment required. Knowledge computerized dictating systems preferred.
  • Ability to maintain a 95% accuracy rate (retrospective coding) and to process a minimum of 15 charts per day (quality reviews). 
  • Effective oral and written communication skills are required to work with medical, nursing, and other allied health staff as well as external medical facilities requesting medical record information, and in maintaining procedure coding manuals.

We are an Equal Opportunity/Affirmative Action employer.  All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected veteran status, age, or any other characteristic protected by law. 
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