Coding Quality Auditor

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Join the Cleveland Clinic team, where you will work alongside passionate caregivers and provide patient-first healthcare. Cleveland Clinic is recognized as one of the top hospitals in the nation. At Cleveland Clinic, you will receive endless support and appreciation and build a rewarding career with one of the most respected healthcare organizations in the world.

As a Coding Quality Auditor, you will be responsible for assessing the accuracy and completeness of inpatient and outpatient medical record documentation through the conduct of random and focused coding audits. You will document findings, prepare and present audit results and perform investigations to provide comprehensive feedback. In this capacity, you will serve as a subject matter expert in coding, offering guidance and support to ensure compliance with established coding standards, regulatory requirements and organizational best practices.

A caregiver in this role works remotely from 8:00 a.m. – 5:00 p.m.

A caregiver who excels in this role will:

• Audit Electronic Medical Records, procedural cases and surgical cases, including pre-bill coding, DRG and APC quality audits, case mix analysis and compliance software reviews for highly complex cases.

• Provide feedback on the application of coding guidelines, practices, proper documentation techniques, data quality improvements and revenue enhancement opportunities.

• Perform retrospective and concurrent audits in accordance with coding guidelines to ensure coding accuracy and proper reporting.

• Prepare and present reports for pre-bill and retrospective coding audits directly to Providers and coding staff.

• Analyze coded data to identify areas of risk and provide recommendations for documentation improvement.

• Assist in the development of programs and procedures to improve coding accuracy rates.

• Interact with Providers and coding staff to resolve documentation or coding issues.

• Respond to coding questions from assigned coders and Providers, providing official coding references and guidelines.

• Maintain routine interaction with Providers and coding staff to address and resolve medical record documentation and coding issues.

• Assist in the facilitation of scheduled external audits.

• Analyze case mix reports and other statistical reports to support coding quality and compliance initiatives.

• Maintain current knowledge of coding principles and guidelines as conventions are updated.

• Monitor and analyze industry trends and issues for potential organizational impact.

• Report compliance and risk issues to the compliance department and provide suggestions for process improvements.

• Recommend changes to coding policies and guidelines to enhance accuracy and compliance.

Minimum qualifications for the ideal future caregiver include:

• High School Diploma and five years of professional coding experience

• OR Associate’s Degree and four years of professional coding experience

• OR Bachelor’s Degree and three years of professional coding experience

• ONE of the following certifications is REQUIRED and must be maintained: the American Health Information Management Association (AHIMA) Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Coding Specialist (CCS), Certified Coding Specialist-Physician (CCS-P), or the American Academy of Professional Coders (AAPC) Certified Inpatient Coder (CIC) or Certified Professional Coder (CPC)

• Proficient in Microsoft Office Applications (e.g., Word, Excel)

• In depth knowledge of ICD-10-CM/PCS coding principles, CPT coding principles, DRG assignment, APC assignment and modifier assignment

• Knowledge of human anatomy and physiological disease processes

• Knowledge of medical terminology

• Knowledge of auditing concepts and principles

• Coding assessment relevant to the work may be required

Preferred qualifications for the ideal future caregiver include:

• Bachelor’s or Associate’s degree

• Specific training related to CPT procedural coding and ICD-10 diagnostic coding through continuing education programs/seminars and/or community college

• Two years of progressive on-the-job experience as a coding quality auditor in a health care environment and/or medical office setting

• Inpatient Coding experience

• Denial experience

Our caregivers continue to create the best outcomes for our patients across each of our facilities. Click the link and see how we’re dedicated to providing what matters most to you: https://jobs.clevelandclinic.org/benefits-2/

Physical Requirements:

• Requires the ability to sit and be stationary for prolonged periods of time.

• Normal or corrected vision.

• Manual dexterity sufficient to perform work on a personal computer.

• May be required to travel to off-site hospitals.

Personal Protective Equipment:

• Follows standard precautions using personal protective equipment as required.

The policy of Cleveland Clinic Health System and its system hospitals (Cleveland Clinic Health System) is to provide equal opportunity to all of our caregivers and applicants for employment in our tobacco free and drug free environment. All offers of employment are followed by testing for controlled substance and nicotine. All offers of employment are follwed by testing for controlled substances and nicotine. All new caregivers must clear a nicotine test within their 90-day new hire period. Candidates for employment who are impacted by Cleveland Clinic Health System's Smoking Policy will be permitted to reapply for open positions after one year.

Cleveland Clinic Health System administers an influenza prevention program. You will be required to comply with this program, which will include obtaining an influenza vaccination on an annual basis or obtaining an approved exemption.

Decisions concerning employment, transfers and promotions are made upon the basis of the best qualified candidate without regard to color, race, religion, national origin, age, sex, sexual orientation, marital status, ancestry, status as a disabled or Vietnam era veteran or any other characteristic protected by law. Information provided on this application may be shared with any Cleveland Clinic Health System facility.

Please review the Equal Employment Opportunity poster.

Cleveland Clinic Health System is pleased to be an equal employment employer: Women / Minorities / Veterans / Individuals with Disabilities