Senior Coding Compliance Auditor

The Senior Coding Compliance Auditor is responsible for analyzing, reviewing and resolving coding and documentation issues that are related to reimbursement, compliance and revenue enhancement.

Hours:

Full time, 40 hours per week

Monday - Friday

8am - 4:30 pm (FLEXIBLE HOURS)

Location:

REMOTE: Our organization is registered for the following states only: MD, VA, DC, FL, PA, and DE. To be considered, relocation is required to one of the registered states if not currently residing in one

Qualifiications:

• High School Diploma or GED, Bachelor's Degree preferred.
• Requires minimum of 5 years of inpatient and/or outpatient coding and auditing experience, which must include 1 years in a leadership position. DRG experience (MS-DRG, APR-DRG) with APR-DRG audit, coding quality or validation experience preferred.
• Prior coding project management (e.g., consulting firm, healthcare or education vendor, etc.) experience is preferred. In addition, experience as an inpatient clinical documentation specialist, will be considered as relevant coding experience.
• This is a remote position and prior remote work experience is preferred.

Required Licensures and Certifications:

Requires Certified Coding Specialist (CCS) certification. RHIT or RHIA credentials preferred. AHIMA inpatient coding assessment will be required to be taken prior to hire.

Please review our wonderful benefits package that included full medical, dental and vision plans as well as tuition reimbursement for yourself and dependents at https://jhh.mybenefitsjhhs.com/

FULL JOB DESCRIPTION:

Position Summary:

This is a senior level position responsible for analyzing, reviewing and resolving coding and documentation issues that are related to reimbursement, compliance and revenue enhancement. The Senior Auditor will review electronic medical record documentation to assure audited accounts were coded with the appropriate diagnosis and procedures to assure a complete and accurate clinical data set in compliance with the audit scope in accordance with the Coding Quality Assurance (CQA) Audit Plan for the fiscal year. The Senior Auditor will document relevant trends identified on audit of inaccurate coding and areas that are high risk for compliance issues to management for audit planning consideration. This position also utilizes advanced knowledge and clinical monitoring expertise to direct effort toward the advancement of accurate coding including research of national coding guidance, Federal guidance and other environmental factors impacting inpatient and outpatient coding standards. r. This individual will conduct investigation and research of existing policies, guidelines and precedent cases in publications such as Federal Register, AHA Coding Clinic, and AHIMA Journal to support research, development and maintenance of JHHS Internal Coding Guidelines. . Additional sources for research may include AHRQ, OIG Coding Compliance Plan and Correct Coding Initiative Guidelines to determine Johns Hopkins Health System (JHHS) internal focused audits plan for the fiscal year or to provide input with Health Information Management (HIM) coding policy development.

The Senior Auditor will manage special projects assigned by management and will represent the Assistant Director, Coding Quality Assurance at meetings and/or conference calls when needed. The position requires a high level of communication with primary business partners including HIM coding leadership and administrative staff, Clinical Documentation Improvement (CDE) leadership and staff and other business partners (e.g., Compliance, Quality Improvement, etc.) and/or other JHHS leadership. The Senior Auditor will attend educational sessions and may be requested to co-present or present topics to health system coding staff in the absence of the Educator, Clinical Documentation Excellence. This individual will serve as a liaison and reference person for administrators, physicians, surgeons, epidemiologists, clinical systems or other clinical or support personnel to respond to coding inquiries. This individual will also serve as a mentor to junior level CQA auditors and adjudicator of internal quality assurance reviews. This position requires high level writing and health writing skills for preparation of formal reports for submission to the JHHS hospitals and Executive Leadership. Audit responsibilities will be performed for all JHHS facilities –by remote access.

This position will also consist of auditing inpatient and outpatient accounts, including automated coded accounts, for diagnoses and procedure coding according to standard coding principles and health system guidelines for adult and pediatric patient populations.

Education:

Requires a High School Diploma or GED. Associates’ or Bachelor’s Degree strongly preferred.

Knowledge:

Requires excellent and comprehensive knowledge of anatomy, physiology, as defined by DRG Medical Diagnostic Categories and all body systems. Strong background knowledge of disease process, pharmacology. Requires college-level knowledge of Medical Terminology and Anatomy & Physiology. Requires a complete and thorough understanding of the unique functions of each clinical area. Must be conversant in, with an advanced knowledge of: ICD-10-CM, ICD-10-PCS, CPT, HCPCS, APR-DRGs, and MS-DRGs. Prior experience with pediatric coding and with complex inpatient spinal fusion coding is a plus. Must possess demonstrable coding and auditing expertise. Must be proficient with Microsoft Word, Excel, and Power Point. Knowledge of Access, knowledge of other programming languages a plus. Requires in-depth knowledge of clinical coding processing and documentation standards, guidelines, policies and procedures. Must be conversant in clinical documentation improvement. High level of proficiency in adult education and training. Knowledge of Hospital bylaws and Joint Commission standards related to departmental activities a plus. Requires knowledge of clinical pertinence requirements and proficiency in abstraction and data entry into the entire database systems used for electronic medical record review and coding. Must be able to read and interpret electronic and manual documentation generated by healthcare professionals. Requires understanding of HSCRC and CMI impact on hospital budget.

Skills:

Requires analytical ability to allow for interpretation of clinical data in all clinical specialties to determine appropriate diagnoses and procedures supported by clinically pertinent data based on knowledge of ICD-10-CM and ICD-10-PCS, CPT, and HCPCS coding. Requires objectivity in the adjudication of coding discrepancies of cases audited by junior CQA auditors, when performing internal quality assurance review. Requires the ability to mentor junior CQA auditors. Requires excellent written, oral communication and interpersonal skills. Ability to effectively communicate with all HIM Administrative staff, Coding and CDE Professionals and Hospital practitioners is essential. Ability to formally present audit findings to senior level staff and hospital leadership and represent CQA in meetings with multi-disciplinary professionals including physicians, surgeons and other clinical staff. Requires the ability to contribute to or assist with developing and conducting in-service training relative to coding for groups of coding staff. Must demonstrate knowledge of and experience with coding and auditing of inpatient and outpatient medical records. High level of attention to detail. Ability to work independently. Ability to work in a team environment across multiple departments with multi-disciplinary clinical and nonclinical staff.

Required Licensure Certification: Requires Certified Coding Specialist (CCS) certification. RHIT or RHIA credentials preferred. AHIMA inpatient coding assessment will be required to be taken prior to hire.

Work Experience: Requires minimum of 5 years of inpatient and/or outpatient coding and auditing experience, which must include 1 years in a leadership position. DRG experience (MS-DRG, APR-DRG) with APR-DRG audit, coding quality or validation experience preferred. Prior coding project management (e.g., consulting firm, healthcare or education vendor, etc.) experience is preferred. In addition, experience as an inpatient clinical documentation specialist, will be considered as relevant coding experience. This is a remote position and prior remote work experience is preferred.

Machines, Tools, Equipment:

Requires proficiency in abstracting and data entry into all data bases used for coding and clinical documentation. Effectively uses Encoder to properly group diagnoses. Inputs and monitors audit findings in the CQA audit tool.

Problem Solving:

Requires analytical ability in order to complete tasks assigned, gather and interpret data from different courses, and resolve problems.

Information Management:

Must be able to read and understand coding guidelines. Must be able to maintain patient confidentiality.

Johns Hopkins Health System and its affiliates are drug-free workplace employers.

We are committed to providing a healthy and safe environment for our patients, visitors and staff members. The Johns Hopkins Hospital has a tobacco-free at work policy. Employees must refrain from using any tobacco products during their work shifts — including while at lunch or on breaks, and whether they are on or off campus.