Inpatient Coding Auditor

Cedars-Sinai•Los Angeles, CA

About The Position

Under the general direction of the HID Audit Supervisor, the role operates as a Coding Auditor and shall: Monitor coding compliance through prebill and retrospective reviews or audits of ICD and/or CPT codes assigned by coding staff. Monitor coding compliance by performing focused audits on high-risk areas identified by the Office of Inspector General (OIG) and the Centers of Medicare and Medicaid Services (CMS). Identify through focused audits operational and regulatory issues related to coding, documentation, and compliance. Identify and alert to trends found in reviews or data through Summary Reports. Provide education and training for coders and other healthcare professionals in both one on one and group settings. Follow Federal, State, and CSHS Compliance requirements to assist in improved data quality for reporting, research, and accurate billing and reimbursement of services rendered. Assist the HID Coding Department with coding of cases during shortage of staff. Perform additional activities (data quality reports, etc.) as assigned. Opportunity to participate in the Coding Career Ladder Program that could include mentorship. This position may also focus on research and resolution of claim edits identified through the core abstractions system (EPIC) as well as the claim scrubber system (Availity). If assigned, the position will require an elevated level of research capabilities to be able to facilitate appropriate resolution. Expert organizational skills to keep references in order.

Responsibilities

Monitor coding compliance through prebill and retrospective reviews or audits of ICD and/or CPT codes assigned by coding staff.
Monitor coding compliance by performing focused audits on high-risk areas identified by the Office of Inspector General (OIG) and the Centers of Medicare and Medicaid Services (CMS).
Identify through focused audits operational and regulatory issues related to coding, documentation, and compliance.
Identify and alert to trends found in reviews or data through Summary Reports.
Provide education and training for coders and other healthcare professionals in both one on one and group settings.
Follow Federal, State, and CSHS Compliance requirements to assist in improved data quality for reporting, research, and accurate billing and reimbursement of services rendered.
Assist the HID Coding Department with coding of cases during shortage of staff.
Perform additional activities (data quality reports, etc.) as assigned.
Opportunity to participate in the Coding Career Ladder Program that could include mentorship.
This position may also focus on research and resolution of claim edits identified through the core abstractions system (EPIC) as well as the claim scrubber system (Availity). If assigned, the position will require an elevated level of research capabilities to be able to facilitate appropriate resolution. Expert organizational skills to keep references in order.