Responsible for performing Inpatient, ED, Complex and Routine Outpatient production coding audits for the System Office Coding Support Services and Trinity Health Regional Health Ministry (RHM) coders. Uses audit results to provide feedback to coders and audit supervisor in order to improve coding. Provides a high level of technical competency and serves as a subject matter expert regarding coding and documentation. Supports the implementation of coding best practices, coding guidelines and policies to ensure compliance with regulatory requirements.
- Knows, understands, incorporates and demonstrates the mission, vision and values of Trinity Health in leadership behaviors, practices and decisions.
- Maintains a proficient level of knowledge of coding standards along with applicable federal, state and local laws and payer regulations, as well as, applicable policies and procedures in order to ensure adherence in a manner that reflects honest, ethical and professional behavior.
- Performs Inpatient, ED and Outpatient coding audits and determines the appropriate response and feedback to coders identifying coding errors and opportunities for improvement. Ensures audits are consistent with, and adhere to Coding Support Services auditing schedules and standards. Provides complete, accurate, concise and timely audit reports to the audit supervisor.
- Identifies coding, documentation and compliance opportunities. Communicates and delivers findings of coding errors and documentation improvement opportunities to coders and then to the audit supervisor if there is disagreement over audit findings. Provides subject matter expertise and coding education as needed.
- Serves as a resource to those in the Coding Support Services group. Understands the various RHM coding policies and procedures and how to apply them to the coding auditing function.
- Uses established audit tools, e.g., worksheet, database, etc., to perform, record and report on production audit findings to the coders and to the audit supervisor. Participates in meetings with Coding Support Services and provides input on how to improve/enhance the production auditing process.
- Recommends revisions and enhancements to the audit process as a means to improve efficiencies and effectiveness.
- Maintains a working knowledge of applicable Federal, State and local laws, payer regulations, Trinity Health’s Corporate Integrity Program, Standards of Conduct, AHIMA’s Professional Code of Ethics, as well as, other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical and professional behavior
Minimum of three (3) to six (6) years of inpatient coding and/or complex outpatient coding experience such as ambulatory surgery, or professional services coding in a healthcare setting is required. Must be able to demonstrate proficiency in assignment of ICD diagnosis and procedure coding, or HCPCS/CPT coding, including assignment of E/M codes.
Bachelor’s degree or an equivalent combination of education and experience. Must possess at least one (1) of the following licenses/certifications: RHIA, RHIT, RN, CPC, CCS, or professional certification in another healthcare field.