In collaboration with the Clinical Documentation Specialists (CDI), Quality Improvement team and HIM Coding staff, the CDI/Coding Compliance Auditor will perform a variety of audits related to documentation accuracy and specifically, coding accuracy & APR-DRG assignment compliance. Analyzes and evaluates patient care documentation after coding and before billing assigns codes as needed, ensures accuracy of Present on Admission status (POA) and DRGs to validate the documentation supports code specificity per compliance requirements. Performs Pre-bill Audit reviews (PBA) reviews, tracks, trends and reports audit results from the APR-DRG auditors and CDI teams. Provides feedback and education regarding opportunities for documentation improvement to physicians, coders and the CDI team. Provides expertise in ICD coding, DRG assignment, documentation guidance and education and assists in setting goals and priorities for the CDI team. Review coding denials for appropriate and accurate coding. Assists the CDI Manager and team in creation of documentation clarification queries requesting providers to provide additional documentation. Functions as the liaison between the CDI team, Coding staff, Physician Advisors and Providers. Communicates with and educates Physician Advisors and providers regarding areas committees on a monthly or as requested basis. Fosters relationships between all disciplines. Maintains current and thorough knowledge and understanding of clinical documentation improvement, Epic systems, coding schemes, APR-DRG groupers, Cook’s policies, procedures, regulatory requirements and guidelines for documentation, coding and billing/reimbursement.
Education & Experience:
Must have a Bachelor’s degree in Business or Clinical field (i.e. Nursing, Health Information Management); RHIA or RHIT with CCS required.
Must have a minimum of five (5) years current & continuous acute care hospital inpatient coding and APR/DRG/case mix analysis and a minimum of 1-2 years previous clinical documentation improvement experience with advanced knowledge of current codes sets, guidelines and principles required; experience in pediatric setting highly desired.
ICD-10-CM training highly preferred.
Demonstrates superior coding and critical thinking skills with ability to solve problems appropriately using knowledge, and current policies/procedures/guidelines and regulations.
Technically competent and fluent knowledge in navigation of electronic medical record applications, coding decision support tools, including encoders, abstracting & billing systems, electronic medical records (used as coding source documents), and other associated computer applications required.
Proficiency in computer assisted coding/CDI tools, automated coding work flow process and management of coded data integrity highly desired.
Experience using Microsoft Office applications (excel, word, outlook, power point) required.
Ability to remain focused, work well independently and productively with minimal guidance and without direct supervision. Must have sharp analytical and critical thinking skills, must be highly detail oriented, have strong organizational, writing, interpersonal and communication skills with ability to maintain confidentiality, create positive relationships; energetic, flexible, goal and team oriented.
Ability to provide excellent customer service routinely in all types of interactions with all individuals. Demonstrated coding knowledge and proficiency is required through on-site evaluation prior to hire.
Skills assessment required with demonstrated ability to easily articulate knowledge of coding guidelines and procedures.
Licensure, Registration, and/or Certification:
Registered Health Information Administrator (RHIA) or Registered Health Information Technologist (RHIT) with Certified Coding Specialist (CCS) required.
Cook Children's Health Care System embraces an inspiring Promise – to improve the health of every child in our region through the prevention and treatment of illness, disease and injury. Based in Fort Worth, Texas, we’re proud of our long and rich tradition of serving our community.