Clinical Coding Auditor

2 weeks ago


Baltimore, Maryland, United States The University of Maryland Medical System Full time

Position Overview
The University of Maryland Medical System is a comprehensive network of 14 hospitals providing a wide range of academic, community, and specialty medical services throughout Maryland and beyond.

As a recognized national and regional referral center, UMMS excels in trauma, cancer care, neurocare, cardiac care, women's and children's health, and physical rehabilitation.

Being the fourth largest private employer in the Baltimore metropolitan area and among the top 20 employers in Maryland, UMMS offers unparalleled clinical diversity, support, and opportunities for professional advancement.

Job Summary
The Compliance Coding Auditor is responsible for conducting thorough audits of hospital inpatient, ambulatory surgery, observation, and other outpatient encounters to ensure proper reimbursement, compliance with federal and state regulations, and adherence to established coding classification systems such as ICD-10-CM/PCS and CPT-4.

Key Responsibilities
The following duties outline the general nature and level of work performed by individuals in this role. This list is not exhaustive and may include additional responsibilities as assigned:

  • Act as a subject matter expert in clinical coding, employing critical thinking to assess and resolve documentation issues in collaboration with medical staff and clinical documentation specialists.
  • Perform audits of ICD-10 diagnostic codes and CPT-4 procedure codes related to outpatient, ambulatory surgery, and observation visits to ensure compliance and accurate reimbursement.
  • Review complex inpatient cases, including trauma, rehabilitation, neurology, and critical care, utilizing ICD-10-CM and ICD-10-PCS nomenclature to guarantee precise APR-DRG/SOI/ROM and POA assignments.

Qualifications
Education and Experience:

  • High School diploma or equivalent required. Formal training in ICD-10-CM, ICD-10-PCS, and CPT-4 coding is essential.
  • Associates or Bachelor's degree preferred; education may be considered in lieu of experience.
  • A minimum of two years of experience in ICD-10-CM/ICD-10-PCS coding and abstracting in a Level 1 Trauma hospital or four years of inpatient hospital medical record coding experience is required.
  • 2-3 years of ambulatory coding experience is also necessary.

Certifications:
One of the following certifications is required:

  • Certified Coding Specialist (CCS)
  • Registered Health Information Technician (RHIT)
  • Registered Health Information Administrator (RHIA)
  • Certified Inpatient Coder (CIC)

Skills and Abilities
The ideal candidate will possess:

  • Strong analytical and organizational skills
  • Ability to prioritize tasks and meet deadlines while working effectively under pressure
  • Excellent customer service skills and familiarity with general office procedures
  • Problem-solving abilities and capability to work with minimal supervision
  • Basic medical terminology knowledge and proficiency in computer usage, including typing skills

All personal information will be kept confidential in accordance with EEO guidelines.



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