IP Coding Quality Auditor (Remote) I HIM Revenue Cycle I Gainesville
About the position
The IP Coding Quality Auditor position at UF Health is a critical role responsible for the ongoing quality review and assessment of coded hospital data. This position involves performing audits on the accuracy of various coding systems including ICD-10, CPT-4, MS-DRG, APR-DRG, and APC assignments. The auditor will also review claims that have been denied due to coding issues, documentation discrepancies, and clinical validation concerns, and will be tasked with formulating and submitting letters of appeal to rectify these denials. Additionally, the role requires the preparation of detailed reports for management review, identifying trends in coding accuracy and compliance. The auditor will conduct focused retrospective audits as well as regular scheduled audits of individual coders to ensure adherence to coding standards and regulations. This position also involves managing all audits conducted by both internal and external entities, responding to requests for code verification, and collaborating with Coding Supervisors and the Coding Manager to develop educational and training opportunities for staff. The ideal candidate will possess strong analytical skills and a thorough understanding of coding practices, enabling them to contribute effectively to the quality assurance processes within the organization.
Responsibilities
Perform ongoing quality review and assessment of coded hospital data.
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Conduct audits on the accuracy of ICD-10, CPT-4, MS-DRG, APR-DRG, and APC assignments.
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Review claims denied for coding, documentation, and clinical validation, and formulate letters of appeal.
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Prepare reports for management review and identify trends in coding accuracy.
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Conduct focused retrospective audits and regular scheduled audits of individual coders.
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Manage all audits conducted by internal and external entities and respond to requests for code verification.
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Contribute to the development of educational and training opportunities for staff in collaboration with Coding Supervisors and the Coding Manager.
Requirements
Registered Health Information Administrator (RHIA) OR Certified Coding Specialist (CCS) OR Registered Health Information Technician (RHIT) OR Certified Professional Coder (CPC) OR Certified Professional Coder-Hospital (CPC-H) OR Registered Nurse (RN) with education and experiential training in Medical Coding, Utilization Review, Denial Management, Case Management or related functions.
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AHIMA Certified ICD-10-CM/PCS Trainer preferred.
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Minimum 5 years experience in hospital inpatient and/or outpatient medical record review, coding and reimbursement.
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Strong knowledge of ICD-9 CM / ICD 10 CM/PCS and CPT coding and prospective payment systems.
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Proficiency with Microsoft Windows Operating Systems and Office applications such as Word, Excel, PowerPoint, and coding/grouping software.
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Ability to work well with minimal supervision and communicate clearly both written and verbally.
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Ability to generate reports for management review that present audit results clearly.
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Ability to meet deadlines and respond well to frequent changes in regulation.
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Ability to maintain positive and productive relationships with internal and external teams and customers.
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Ability to work independently and be a self-starter.
Nice-to-haves
Coding audit experience preferred.
Benefits
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