United States onlyProvides comprehensive coding audits to ensure accuracy and compliance with regulatory standards, optimize Diagnosis-Related Group (DRG) or Ambulatory Payment Classification (APC) assignments, and support revenue integrity. Delivers coding/auditing education, maintains coding guidelines, and implements updates in alignment with federal and state regulations. Serves as a subject matter expert, providing strategic guidance to audit teams and collaborates across departments to drive quality and performance.
Job Responsibility
1.Perform detailed quality audits of coding/auditing practices to validate accuracy and compliance and optimal DRG/APC assignments.
2.Provide education and training to audit staff, ensuring adherence to coding standards and best practices.
3.Communicate effectively with audit teams, Clinical Documentation Improvement (CDI) staff, and other stakeholders to resolve coding and documentation issues.
4.Maintain current knowledge of federal and state coding guidelines, payer policy, and industry updates; translate changes into operational guidance.
5.Review and validate reassignment requests, ensuring timely and accurate resolution.
6.Implement coding changes, updates and methodology improvements; communicate updates clearly and efficiently to audit teams and partners.
7.Offer strategic advice and guidance to audit teams; contribute to management-level decision-making.
8.Analyze and report coding/auditing trends, statistics, and performance metrics; prepare and present actionable recommendations to leadership.
9.Conduct escalation reviews and collaborate with cross-functional teams to ensure proper coding assignments and to address systemic issues.
10.Lead process improvement initiatives to reduce denials, improve accuracy, and strengthen documentation and coding workflows.
11.Performs related duties as required. All responsibilities noted here are considered essential functions of the job under the Americans with Disabilities Act. Duties not mentioned here, but considered related, are not essential functions.
Job Qualification
- Bachelor's Degree, or equivalent combination of education and related experience.
•Certified Coding Specialist (CCS) or Certified Coding Specialist Physician (CCSP) or Certified Outpatient Coder (COC) or RHIA or RHIT certification, required.
•10+ years of relevant experience and 2+ years of leadership/management experience, required.
*Additional Salary Detail
The salary range and/or hourly rate listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future.When determining a team member's base salary and/or rate, several factors may be considered as applicable (e.g., location, specialty, service line, years of relevant experience, education, credentials, negotiated contracts, budget and internal equity).
