Coding Quality Auditor (Fully Remote)

Benefits

• Health insurance
• Vision insurance

This position supports hospital based coding. Join the Cleveland Clinic team, where you will work alongside passionate caregivers and provide patient-first healthcare. Cleveland Clinic is recognized as one of the top hospitals in the nation. At Cleveland Clinic, you will work alongside passionate and dedicated caregivers, receive endless support and appreciation, and build a rewarding career with one of the most respected healthcare organizations in the world.

The 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, preparing and presenting audit results, including investigations and presenting feedback.

• Acting a coding expert resource.

At Cleveland Clinic, we know what matters most. That's why we treat our caregivers as if they are our own family, and we are always creating ways to be there for you. Here, you'll find that we offer: resources to learn and grow, a fulfilling career for everyone, and comprehensive benefits that invest in your health, your physical and mental well-being and your future. When you join Cleveland Clinic, you'll be part of a supportive caregiver family that will be united in shared values and purpose to fulfill our promise of being the best place to receive care and the best place to work in healthcare.

Responsibilities:

• Responsible for auditing Electronic Medical Records and/or, procedural cases and/or 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.
• 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 preferred.
• 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.
• Ability to present information to various audiences.
• Proficiency in Microsoft Office Applications (e.g., Word, Excel).
• In depth knowledge of ICD-10-CM/PCS coding principles, CPT coding principles, DRG assignment, APC assignment, and modifier assignment.
• Working knowledge of human anatomy and physiology, disease processes.
• Demonstrated knowledge of medical terminology.
• Knowledge of auditing concepts and principles.
• Excellent verbal and written communications.

Work Experience:

• A minimum of 5 years professional coding experience required.
• A minimum of 2 years of progressive on-the-job experience as a coding quality auditor in a health care environment and/or medical office setting preferred.
• 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:

• Ability to perform work in a stationary position for extended periods.
• Ability to travel throughout the hospital system.
• Ability to work with physical records, such as retrieving and filing them.
• Ability to operate a computer and other office equipment.
• Ability to communicate and exchange accurate information.
• In some locations, ability to move up to 25 lbs.

Personal Protective Equipment:

Follows standard precautions using personal protective equipment as required.
Pay Range

Minimum hourly: $27.65

Maximum hourly: $42.17

The pay range displayed on this job posting reflects the anticipated range for new hires. While the pay range is displayed as an hourly rate, Cleveland Clinic recruiters will clarify whether the compensation is hourly or salary. A successful candidate's actual compensation will be determined after taking factors into consideration such as the candidate's work history, experience, skill set, and education. This is not inclusive of the value of Cleveland Clinic's benefits package, which includes among other benefits, healthcare/dental/vision and retirement.