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Inpatient Coding Quality Auditor

3 months ago

Manila, National Capital Region, Philippines Tenet Global Business Center, Inc. Full time

Job Description:

The Auditor, Coding Quality conducts Initial Coding Quality Reviews (IQRs), Monthly Coding Quality Reviews (MQRs), Focused Quality Audits, and other ad hoc coding quality audits as requested to ensure hospital inpatient, outpatient , and profee claims, ICD-10-CM/PCS, and/or CPT codes were coded and billed in accordance with nationally recognized coding guidelines, standards, regulations and regulatory requirements, as well as corporate coding compliance policies. The Quality Auditor's role is designed to ensure the integrity of Conifer's coding program is consistently maintained. The Coding Quality Auditor will deliver written and verbal reports of findings to other department staff members, as well as hospital, region, and/or corporate operations staff as indicated. The Senior Coding Quality Auditor will escalate significant trends to Manager of Coding Quality & Performance, leadership and/or Conifer Compliance team as warranted.

Duties and responsibilities:

  1. Understands, interprets and applies coding guidelines for coding quality audits. Audits inpatient, outpatient, and profee encounters with complex code assignments.
  2. Review of complex medical records to determine coding accuracy of all documented diagnoses and procedures.
  3. Reviews claims to validate submitted codes and abstracted data including but not limited to ICD-10- CM//PCS codes, MS-DRGs, APR-DRGs, CPT's, APC's, and discharge disposition which allimpact facility reimbursement and RVUs which impact profee reimbursement.Required Certifications/Licensure:
  4. Coder Certification such as CCS, CIC, CPCWorking Conditions:
  5. Amenable to work in BGC
  6. Willing to work in a dayshift scheduleCompany Benefits:
  7. Competitive Salary
  8. HMO on day 1 plus 1 dependent; Additional 2 HMO dependents upon regularization
  9. Group life insurance
  10. PTO Credits
  11. Annual Appraisal
  12. Annual Performance Bonus