HIS OP Coding Quality Auditor

Northside Hospital is award-winning, state-of-the-art, and continually growing. Constantly expanding the quality and reach of our care to our patients and communities creates even more opportunity for the best healthcare professionals in Atlanta and beyond. Discover all the possibilities of a career at Northside today.

OCCUPATIONAL SUMMARY

Under the supervision of the HIS OP Coding Reimbursement/Coordinator, coordinates day to day coding activities. Daily monitors the QuadraMed Compliance software system to ensure coding edits are completed in an accurate and timely manner for billing purposes. Works with respective departments to obtain medical record documentation for coding. Assists the OP HIS Coding Reimbursement/Coordinator in monitoring data for coding compliance and ensuring suspense levels within accepted turn around times. Communicates as needed with Lexicode to monitor OP daily unbilled.

PRIMARY DUTIES AND RESPONSIBILITIES

1. Audits OP accounts including Business Office account hold list, release list and follow up

2. Assists with AHRQ review as necessary

3. Provides Lexicode with daily reports: D/C lists, Completed Abstract reports and Suspense.

4. Communicates with clinical departments regarding insufficient documentation on individual accounts

5. Assists with Physician Query Process

6. Assists with Case Management IP only requests as necessary

7. Assists with Decision Support request as necessary

8. Assists OP HIS Coding Reimbursement/Coordinator as needed in monitoring coding compliance and appropriate clinical documentation on a case by case basis.

9. Assists OP HIS Coding Reimbursement/Coordinator as needed in monitoring coding compliance and appropriate clinical documentation on a case by case basis including infusion therapy coding, outpatient surgery/GI procedure diagnosis and procedure coding.

10. Serves as liaison for various internal and external coding reviews, assists with chart location, and investigates missing medical records and documentation

11. Prepares monthly data for compliance, productivity and quality reporting.

12. Communicate one on one with Lexicode to maintain OP unbilled at established levels

13. Works daily with Lexicode to resolve Northside Hospital issues to code individual records i.e., chart location, double numbers.

14. Participates in educational programs and in-service meetings.

15. Attends meetings as required

16. Performs other related duties as identified.

17. Works with Business Office program including: Pending, CCI, LMRP, ESA, and Medicaid Precert program.

REQUIRED:

1. Certification in one of the following: Certified Coding Specialist (CCS) or successful completion of CCS exam within 6 months of hire, or Registered Health Information Technician (RHIT) or Registered Health Information Administrator (RHIA). 2. Two (2) years experience in Acute Care, CPT and ICD-9-CM coding. 3. One (1) year experience in quality review. 4. Demonstrates proficiency in Microsoft Office( products. The ability to develop spreadsheets and databases, and import/export files, etc. 5. Previous experience with encoder software.

PREFERRED:

1. Certified Coding Specialist (CCS), or Registered Health Information Administrator (RHIA). 2. Three + years experience in quality review. 3. Three (3) to five (5) years' experience in Acute Care, CPT-ICD-9-CM codes. 4. Previous experience with compliance software. Previous imaging system and/or HBOC products.