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Cleveland Clinic Senior Coding Quality Auditor in Cleveland, Ohio

Job Summary:

The Senior Coding Quality Auditor is responsible for assessing coding accuracy and completeness of inpatient and outpatient medical record documentation by conducting random and focused coding audits; documenting, preparation and presentation of audit results; including investigations and presentation of feedback. Acts as coding resource to other auditors and provides direction as needed.

Responsibilities :

  • Responsible for auditing Electronic Medical Records, procedural cases, surgical cases, pre-bill coding, DRG and APC Quality Audits, case mix analysis, and compliance software reviews on highly complex cases.

  • Responsible for providing feedback on the application of coding guidelines, practices, and proper documentation techniques, data quality improvements, and revenue enhancements.

  • Performs retrospective and concurrent audits based on coding guidelines to ensure coding accuracy and proper reporting.

  • Prepares and presents reports for pre-bill and retrospective coding audits directly to audited Providers and coders.

  • Demonstrates the ability to analyze coded data to identify areas of risk and provide suggestions for documentation improvement.

  • Assists in the development of programs and procedures to support improvement of coding accuracy rate.

  • Interacts with Providers, and coding staff to resolve documentation or coding issues. Provides direction to other auditors and resolves issues across multiple Institutes.

  • Responds to coding questions from assigned coders /providers and provides official coding references and guidelines.

  • Provides routine interaction with Providers, and coding staff to assist with or resolve issues relating to medical record documentation and coding.

  • Assists with the facilitation of scheduled external audits.

  • Assists with the analysis of case mix reports and other statistical reports.

  • Maintains current knowledge of coding principles and guidelines as coding conventions are updated; monitors and analyzes current industry trends and issues for potential organizational impact.

  • Reports any compliance and/or risk issues to the compliance department. Provides suggestions on process improvement.

  • Makes recommendations for coding policy/guideline changes.

  • Other duties as assigned.

Education :

  • High School Diploma required.

  • Associate’s Degree preferred.

  • A Bachelor’s Degree in Health Information Management preferred.

  • A minimum of 3 years of progressive on-the-job experience as a coding quality auditor in a health care environment and/or medical office setting required.

  • Specific training related to CPT procedural coding and ICD-10 diagnostic coding through continuing education programs/seminars and/or community college preferred.

Certifications :

  • A minimum of one of the following certifications is required and must be maintained: the American Health Information Management Association (AHIMA) Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Coding Specialist (CCS) , Certified Coding Specialist-Physician (CCS-P), or the American Academy of Professional Coders (AAPC) Certified Inpatient Coder (CIC) or Certified Professional Coder (CPC).

Complexity of Work:

  • Coding assessment relevant to the work may be required.

  • Working knowledge of human anatomy and physiology, disease processes.

  • Demonstrated knowledge of medical terminology.

  • In depth knowledge of ICD-10 CM/PCS coding principles, CPT coding principles, DRG assignment, APC assignment and modifier assignment.

  • Knowledge of auditing concepts and principles.

  • Excellent verbal and written communications.

  • Ability to accurately apply coding principles to both professional and technical hospital encounters.

  • Ability to present information to various audiences.

  • Proficiency in Microsoft Office applications (e.g., Word, Excel).

Work Experience :

  • A minimum of 7 years professional coding experience required.

  • An Associate’s Degree may offset up to 1 years of required experience.

  • A Bachelor’s Degree may offset up to 2 years of required experience.

Physical Requirements :

  • Requires the ability to sit and be stationary for prolonged periods of time.

  • Normal or corrected vision.

  • Manual dexterity sufficient to perform work on a personal computer.

  • May be required to travel to off-site hospitals.

Personal Protective Equipment:

  • Follows standard precautions using personal protective equipment as required.

The policy of Cleveland Clinic and its system hospitals (Cleveland Clinic) is to provide equal opportunity to all of our employees and applicants for employment in our tobacco free and drug free environment. All offers of employment are followed by testing for controlled substance and nicotine. Job offers will be rescinded for candidates for employment who test positive for nicotine. Candidates for employment who are impacted by Cleveland Clinic’s Smoking Policy will be permitted to reapply for open positions after 90 days. Decisions concerning employment, transfers and promotions are made upon the basis of the best qualified candidate without regard to color, race, religion, national origin, age, sex, sexual orientation, marital status, ancestry, status as a disabled or Vietnam era veteran or any other characteristic protected by law. Information provided on this application may be shared with any Cleveland Clinic facility.

Cleveland Clinic is pleased to be an equal employment employer: Women/Minorities/Veterans/Individuals with Disabilities