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Inpatient Coding Quality Analyst
2 months ago
Company: IASIS Healthcare
Job Overview:
As an Inpatient Coding Quality Analyst, you will be responsible for conducting comprehensive audits of inpatient coding to ensure that code assignments are accurately supported by clinical documentation within medical records. This role requires a high level of proficiency in the assignment of ICD-10-CM and PCS codes.
Key Responsibilities:
- Execute coding audits on a diverse range of complex inpatient records to verify the accuracy of ICD-10-CM, PCS codes, MS-DRG, and/or APR DRG assignments.
- Provide detailed written rationales and supporting evidence for recommendations based on audit findings.
- Deliver educational feedback to coding personnel regarding audit results.
- Assist coding staff and management in identifying and resolving coding discrepancies.
- Spot opportunities for documentation enhancement that influence coding precision.
- Initiate physician queries for clarification of documentation to ensure correct code assignment.
- Collaborate with the clinical documentation improvement team to resolve conflicts in code assignments.
- Review and analyze billing edits.
- Support with DRG denials from payers, including researching and drafting appeal letters.
- Interpret Medicare and NCCI guidelines, as well as National and Local Coverage Determinations, to ensure coding compliance.
- Maintain a minimum accuracy rate of 95% on all coding audits.
- Achieve a productivity standard of approximately 20 inpatient coding reviews per day.
Additional Duties:
Perform other assigned tasks, including training and mentoring new staff, as well as conducting research related to special projects.
Required Knowledge & Skills:
- Thorough understanding of coding guidelines, Coding Clinics, and relevant coding references, with the ability to apply these resources to audit findings.
- Exceptional verbal and written communication skills to effectively convey information to both internal and external stakeholders.
- Strong organizational skills to track and trend audit findings efficiently.
- Excellent problem-solving abilities, with the capacity to work independently and under pressure while maintaining a collaborative approach.
- Proficient in computer and technical skills, with experience in MS Word, Excel, and PowerPoint.
- Ability to meet deadlines consistently.
Education/Experience/Certification:
- Associate's degree in Health Information (RHIT) or a related healthcare field.
- 3-5 years of progressive coding experience in an acute care hospital environment, including auditing.
- AHIMA certification required, such as RHIA, RHIT, or CCS.
- Experience with Meditech and 3M 360 is essential; Cerner experience is advantageous.
Other Information:
This is a remote position. Expected travel is up to 10% for educational purposes and company growth.