Auditor DRG - Phoenix, United States - HonorHealth

Description

Overview:

Position is working remote - work from home.

Work Schedule is negotiable - standard 8:00am - 4:30pm

Looking to be part of something more meaningful? At HonorHealth, youll be part of a team, creating a multi-dimensional care experience for our patients. Youll have opportunities to make a difference. From our Ambassador Movement to our robust training and development programs, you can select where and how you want to make an impact.

HonorHealth offers a diverse benefits portfolio for our full-time and part-time team members designed to help you and your family live your best lives. Visit to learn more.

Join us. Lets go beyond expectations and transform healthcare together.

HonorHealth is a non-profit, local community healthcare system serving an area of 1.6 million people in the greater Phoenix area. The network encompasses six acute-care hospitals, an extensive medical group, outpatient surgery centers, a cancer care network, clinical research, medical education, a foundation, and community services with approximately 13,100 team members, 3,500 affiliated providers and nearly 700 volunteers. HonorHealth was formed by a merger between Scottsdale Healthcare and John C. Lincoln Health Network. HonorHealths mission is to improve the health and well-being of those we serve.

Education
High School Diploma or GED Required

Experience
3 years inpatient coding Required

Licenses and Certifications
Non ClinicalCCS - Certified Coding Specialist CCS (Certified Coding Specialist) or
CIC (Certified Inpatient Coder) or
CPC-H/COC (Certified Outpatient Coder) Upon Hire Required

Job Summary
The DRG Auditor is responsible for performing an in-depth review of select inpatient medical records to ensure that the assigned codes and DRG are supported by clinical documentation and all diagnoses and procedures are coded with the required specificity and the discharge disposition and the POA are correct Knowledge of IPPS methodology is required. Responsible for mentoring and training other coders. Provide ongoing feedback and education to coding staff and Clinical Documentation Specialists.

Responsible for researching new technology for accurate code assignment. Assign and sequence ICD-10-CM, ICD-10-PCS, CPT and HCPCs diagnostic and procedural codes for all inpatient records for data retrieval, billing, and reimbursement. Perform documentation assessment and review for accurate abstracting of clinical data to meet regulatory and compliance requirements. Assist management with assigned special projects.

• Assigns and sequences ICD-10-CM, ICD-10/-PCS, CPT and HCPCs diagnostic and procedural codes for inpatient and/or outpatient accounts within HonorHealth. Reviews physician documentation & coding for appropriateness & accuracy and makes corrections following Medicare & AMA coding guidelines. Assigns DRG and performs DRG validation as applicable. Reviews and provides coding guidance to coding staff. Utilizes electronic medical record and computer-assisted coding (CAC) software. Addresses NCCI, OCE, LCD, and other applicable coding edits.
• Complies with system-wide coding practices to meet corporate compliance guidelines and to ensure appropriate and effective reimbursement with Patient Financial Services, medical staff and various departments. Reviews and analyzes medical records for accurate ICD and CPT code selection.
• Mentors and educates coding staff and providers to ensure timely notification of identified trends that might impact revenue or compliance. Educates assigned providers on appropriate coding and documentation and provide supporting documentation to enhance awareness and corrections needed for accurate coding.
• Participates in special projects involving coding, payer testing, and other project that interface with coding. Assists Patient Financial Services with interpretation and selection of appropriate ICD/CPT codes and /or other information requested for accurate billing and reimbursement. Possesses knowledge and understanding of failed bill parameters.
• Performs charge reconciliation to ensure all submitted charges are posted timely and balance with total submitted charges. Assigns charges as applicable.
• Communicates with hospital and outside agencies to reconcile issues affecting the coding department, including denials, coding errors, guideline clarifications, and technical issues. Addresses coding questions from coders and other entities. Resolves coding issues/problems and appropriately seeks assistance from Coding Supervisor.
• Creates and updates information in shared coding drive as applicable, and communicates updates/change to applicable staff. Participates in continuing education activities to enhance knowledge, skills and keep credentials current in order to maintain skill set for outpatient coding.