This position is responsible for ongoing quality review and assessment of coded hospital data. Performs audits on the accuracy of ICD-10, CPT-4, MS-DRG, APR-DRG and APC assignments. Performs reviews of claims denied for coding, documentation and clinical validation. Formulates and submits letters of appeal. Prepares reports for management review and identifies trends. Conducts focused retrospective audits and regularly scheduled audits of individual coders. Manages all audits conducted by internal and external entities and responds to requests for code verification. In conjunction with the coding supervisors and coding manager, contributes to the development of educational and training opportunities for staff.

Minimum Education and Experience Requirements:

• Registered health information administrator (RHIA), certified coding specialist (CCS), registered health information technician (RHIT), certified professional coder (CPC), certified professional coder-hospital (CPC-H) or registered nurse (RN) with education and experiential training in medical coding, utilization review, denial management, case management or related functions. 
• AHIMA-certified ICD-10-CM/PCS trainer preferred. 
• Must have a minimum of five years' experience in hospital inpatient and/or outpatient medical record review, coding and reimbursement. 
• Coding audit experience preferred. 
• Must have strong knowledge of ICD-9 CM/ICD-10 CM/PCS and CPT coding and prospective payment systems.
• Proficiency with Microsoft Windows operating systems; Office applications, such as Word, Excel and PowerPoint; and coding/grouping software. 
• Able to work well with minimal supervision. 
• Able to communicate clearly (both written and verbally). 
• Able to generate reports for management review that present audit results in a clear manner.
• Able to meet deadlines and respond well to frequent changes in regulation. 
• Able to maintain positive and productive relationships with internal and external teams and customers. 
• Able to work independently and be a self-starter.

Motor Vehicle Operator Designation:

• Employees in this position will operate vehicles for an assigned business purpose as a "non-frequent driver."

Licensure/Certification/Registration:

• Registered health information administrator (RHIA), certified coding specialist (CCS), registered health information technician (RHIT), certified professional coder (CPC), certified professional coder-hospital (CPC-H) or registered nurse (RN).