Inpatient Coding Quality Auditor

4 weeks ago

Taguig, Philippines Conifer Health Solutions Full time

Overview

Inpatient Coding Quality Auditor role at Conifer Health Solutions. 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 to ensure hospital inpatient, outpatient, and profee claims, ICD-10-CM/PCS, and/or CPT codes are 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 delivers written and verbal reports of findings to department staff, hospital, region, and/or corporate operations staff as indicated. The Senior Coding Quality Auditor escalates significant trends to the Manager of Coding Quality & Performance, leadership and/or Conifer Compliance team as warranted.

Duties and responsibilities
  • Understands, interprets and applies coding guidelines for coding quality audits. Audits inpatient, outpatient, and profee encounters with complex code assignments.
  • Reviews complex medical records to determine coding accuracy of all documented diagnoses and procedures.
  • Reviews claims to validate submitted codes and abstracted data including ICD-10-CM/PCS, MS-DRGs, APR-DRGs, CPTs, APCs, and discharge disposition which impact facility reimbursement and RVUs which impact profee reimbursement.
Qualifications
  • Required Certifications/Licensure: Coder Certification such as CCS, CIC, CPC
Working Conditions
  • Amenable to work in BGC
  • Willing to work in a dayshift schedule
Company Benefits
  • 100K SIGN-ON BONUS
  • HMO with 2 FREE dependents
  • Group life insurance
  • PTO Credits
  • Annual Performance Bonus
Seniority level
  • Mid-Senior level
Employment type
  • Full-time
Job function
  • Administrative
Industries
  • Hospitals and Health Care
  • Administrative and Support Services
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