Clinical Coding Quality Auditor
2 weeks ago
Position Overview
The University of Maryland Medical System is a comprehensive healthcare network comprising 14 hospitals, offering a wide range of academic, community, and specialized medical services across Maryland and beyond.
As a recognized national and regional referral center, UMMS excels in trauma, cancer care, neurocare, cardiac services, 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 provides unparalleled clinical diversity, robust support, and numerous opportunities for professional advancement.
Job Responsibilities
1. **General Summary**
Conduct thorough audits of hospital inpatient, ambulatory surgery, observation, and other outpatient encounters to ensure appropriate reimbursement, compliance with federal and state regulations, and adherence to established ICD-10-CM/PCS coding and CPT-4 procedure coding systems.
2. **Key Duties**
- Act as a clinical coding subject matter expert, employing critical thinking to assess and resolve documentation issues in collaboration with medical staff and clinical documentation specialists as necessary.
- Perform audits of ICD-10 diagnostic codes and CPT-4 procedure codes for outpatient, ambulatory surgery, and observation visits, ensuring compliance with regulatory standards.
- Evaluate complex inpatient cases, including trauma, rehabilitation, neurology, and critical care, utilizing ICD-10-CM and ICD-10-PCS nomenclature to guarantee accurate 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. An Associate's or Bachelor's degree may be considered in lieu of experience.
- A minimum of two years of experience in ICD-10-CM/ICD-10-PCS coding and abstracting at a Level 1 Trauma hospital, or four years of inpatient hospital medical record coding experience.
- 2-3 years of ambulatory coding experience is preferred.
**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
- Strong analytical and organizational skills, with the ability to manage filing systems and prioritize workloads effectively.
- Excellent customer service skills and familiarity with general office procedures.
- Capable of problem-solving and working independently with minimal supervision.
- Proficient in basic medical terminology and computer skills, including typing.
Additional Information
All information will be kept confidential in accordance with EEO guidelines.
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