Senior Auditor CDI and Coding

4 weeks ago


Columbia MD United States MEDSTAR HEALTH Full time
Responsibility for independently performing CDI, inpatient and outpatient coding/billing audits and other projects as assigned by the Vice President of Internal Audit (IA) or the Senior Audit Manager, IA. Such work includes, but is not limited to, completing audits for the organization to ensure controls are in place and functioning as intended. This will be accomplished by assessing risks, analyzing controls, and ensuring that business practices are effective, efficient, and compliant with MedStar policies and regulatory requirements. Demonstrates a thorough understanding of complex inpatient and outpatient coding and billing concepts,(including MS-DRGs, ICD-9-CM, ICD-10-CM, ICD-10-PCS, CPT, E&M, Modifiers), CDI compliance with REGS.DOC.001- REGS.DOC.004, and auditing concepts; discusses complex coding, CDI, and auditing issues with IA and client management; keeps informed of professional standards and company/department policies and procedures and effectively applies this knowledge to complex client situations.
Education
  • Bachelor's degree in Health Information Management required or
  • Accounting. required
Experience
  • 3-4 years 4 years health information management coding experience in an acute care setting; experience with computer systems for encoding and abstracting required and
  • Auditing experience preferred
Licenses and Certifications
  • Certified as a RHIT (Registered Health Information Technician) or RHIA (Registered Health Information Administrator), with CCS (Certified Coding Specialist) required
Knowledge, Skills, and Abilities
  • Proficient in 3M encoder/grouper, Microsoft Word, Excel and/or Access, PowerPoint.
  • Excellent interpersonal skills, including verbal and written communication.
  • Good public speaking and presentation skills.
  • Experience with data analysis / computer assisted audit techniques (CAAT) and tools and audit management software is a plus.
Contributes to the achievement of established department goals and objectives, and adheres to IA department policies, procedures, quality standards and safety standards. Complies with governmental and accreditation regulations. Embodies and demonstrates the Mission, Vision and Spirit Values of MedStar.Analyzes findings to identify root causes. Communicates ideas appropriately, develops recommendations, and participates in the preparation of audit reports and presentations to management.Develops audit programs and working papers detailing audit procedures/techniques executed in complex, judgmental and specialized areas of inpatient and outpatient coding and billing and clinical documentation improvement. Obtains adequate audit evidence in accordance with IA department and professional standards.Plans and performs audits according to the Annual Internal Audit Plan.Provides innovative and creative ideas to formulate new audit and risk assessment approaches.Stays abreast of general industry, regulatory and economic developments and applies their understanding to identify areas of audit significance, assesses the degree of risk and the nature of the errors that could result from coding and billing errors, identifies unusual or unexpected transactions and processes, and demonstrates a broader understanding by recognizing business trends and emerging technical and industry developments of relevance to share with the client engagement team.Uses Computer-Assisted Audit Techniques (CAAT) as appropriate on projects.Participates in meetings and on committees and represents the department and hospital in community outreach efforts. Participates in multi-disciplinary quality and service improvement teams.Performs other duties as assigned.

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