Medical Record Documentation Coding Review Auditor

Shift: Day
Schedule: Full - Time Regular

Ardent Health Services invests in people, technology, facilities and communities, producing high-quality care and extraordinary results. Based in Nashville, Tennessee, Ardent's subsidiaries own and operate 31 hospitals in seven states with more than 25,000 employees including 1,150 employed providers. Ardent facilities exceed national averages in Overall Hospital Quality Star Rating as ranked by the Centers for Medicare & Medicaid Services; 89 percent of its hospitals received a three-star rating or above in comparison with 73 percent of all hospitals ranked. Seven of the company's hospitals were recognized by Modern Healthcare as "Best Places to Work" in 2017 – more than any other system in the country. Ardent's corporate office was named "Top Work Places" for Nashville based companies in 2017 and 2018.

We have an exciting opportunity to join our team as a Medical Record Documentation and Coding Review Auditor .

Under indirect supervision, the Medical Record Documentation and Coding Review Auditor (Auditor) audits medical records to ensure compliance with federal and state coding regulations and guidelines. This role uses knowledge of Ardent coding policies, Coding Clinics and Coding guidelines to produce a thorough review of coding and abstracting ensuring the coding and abstracting conforms to compliant coding. The Auditor reviews insurance payments and denials and recommends billing corrections; trains staff members on the coding process; and acts as a liaison between Ardent Health Services corporate compliance and each Ardent market to escalate any coding quality issues.

The Auditor is responsible for the following duties:

ESSENTIAL DUTIES AND RESPONSIBILITIES:       

  • Audits medical record documentation to identify undercoded and overcoded charts.
  • Provides second-level review of billing performances to ensure compliance with legal and procedural policies and to ensure optimal reimbursements while adhering to regulations prohibiting unbundling and other questionable practices.
  • Researches, analyzes, and responds to inquiries regarding compliance, inappropriate coding, denials, and billable services.
  • Manage audit workflow and productivity, as requested.
  • Communicate with the designated point-of-contact(s) within Ardent markets; provide information on progress, actions and issues in a timely manner.
  • Interacts with physicians and other patient care providers regarding billing and documentation policies, procedures, and regulations; obtains clarification of conflicting, ambiguous, or non-specific documentation.
  • Trains, instructs, and/or provides technical support to medical providers and Medical Coding Analysts as appropriate regarding coding compliance documentation, and regulatory provisions, and third party payer requirements.
  • Reviews, develops, modifies, and/or adapts relevant client procedures, protocols, and data management systems to coordinate these with UNM methodology, to ensure that client billing operations meet the joint requirements of both the local facility and UPA.
  • Interacts with providers and management to review and/or implement codes and to update charge documents.
  • Ensures strict confidentiality of financial records.
  • Attends coding conferences, workshops, and in-house sessions to receive updated coding information and changes in coding and/or regulations.
  • Performs miscellaneous job-related duties as assigned.

KNOWLEDGE, SKILLS AND ABILITIES REQUIRED:

  • Knowledge of auditing concepts and principals.
  • Advanced knowledge of medical coding, billings systems and regulatory requirements.
  • Ability to prioritize and multi-task in a fast-paced, changing environment.
  • Ability to use independent judgement and to manage and impart confidential information.
  • Ability to analyze and solve problems.
  • Knowledge of current and developing issues and trends in medical coding procedure requirements.
  • Demonstrate ability to working in all work types and specialties.
  • Demonstrate ability to self-motivate, set goals, and meet deadlines.
  • Demonstrate leadership, mentoring, and interpersonal skills.
  • Demonstrate excellent presentation, verbal and written communication skills.
  • Ability to develop and maintain relationships with key business partners by building personal credibility and trust.
  • Maintain courteous and professional working relationships with employees at all levels of the organization.
  • Demonstrate excellent analytical, critical thinking and problem solving skills.
  • Skill in operating a personal computer and utilizing a variety of software applications.
  • Knowledge of coding convention and rules established by the American Medical Association (AMA), the American Hospital Association (AHA) and the Center for Medicare and Medicaid (CMS), for assignment of diagnostic and surgical procedural codes.
  • Knowledge of JCAHO, coding compliance and HIPAA HITECH standards affecting medical records and the impact on reimbursement and accreditation.
  • Commitment and adherence to Ardent Health’s Core Values.

EDUCATION AND EXPERIENCE: 

  • Associate’s degree in Health Information Management or Associate’s degree in Nursing, Bachelor’s degree preferred
  • Minimum of ten (10) years of coding/nursing experience with DRG or APC auditing experience
  • Clinical documentation experience and credentials highly recommended
  • EPIC experience is a plus
  • Direct RAC audit experience may be substituted for years of coding experience

 CERTIFICATES AND/OR LICENSES:

  CCS, CPC, CPC-H, RHIA, RHIT, CDIP, CCDS, RN