QA Auditor Inpatient & Provider - RCO Coding
JOB SUMMARY:
To implement and provide internal coding and documentation quality review to ensure compliance with documentation supports the coded services; to report any coding discrepancies; and to provide training to coders and providers to eliminate any discrepancies. This position provides a standardized coding education program to Coders.
REQUIRED EDUCATION / EXPERIENCE:
Bachelor’s Degree in related field or equivalent and three years of related experience. Three (3) years complex multi-specialty Inpatient Coding experience. Must be effective in communicating down, horizontal and upward to the VP level regarding metrics, operations and projects representing the entire coding department. Current RIHA, RHIT, CCS, CPC, CPC-H, CCS-P or related certification as approved by department leadership.
ESSENTIAL JOB FUNCTIONS:
• Develops internal coding and documentation auditing programs to address both inpatient and professional coding issues.
• Performs internal coding and documentation quality reviews of coded inpatient and professional services to verify accuracy and specificity of assigned codes.
• Develops RCO coder education to address issues identified by monitoring based on audit results.
• Assists with analysis of data/reports monitoring activities to help identify trends, issues, risk areas, and opportunities for coder and provider education.
• Prepares and presents reports summarizing education activities.
• Keeps RCO Leadership informed of audit progress.
• Manages the education activities so time is used efficiently, and departmental quality management standards are met.
• Maintains current knowledge regarding federal, state, and local coding and compliance guidance, initiatives, work plans, and payer regulations. Communicates and provides this information to coders in a timely manner.
• Ensures that coding education standards are updated appropriately to reflect regulatory changes.
• Educate and offer feedback to providers as needed to ensure that documentation is complete, accurate and compliant with guidelines.
• Performs related duties as required.
Equal Employment Opportunity
UTMB Health strives to provide equal opportunity employment without regard to race, color, religion, age, national origin, sex, gender, sexual orientation, gender identity/expression, genetic information, disability, veteran status, or any other basis protected by institutional policy or by federal, state or local laws unless such distinction is required by law. As a Federal Contractor, UTMB Health takes affirmative action to hire and advance protected veterans and individuals with disabilities.
