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Coding Compliance Auditor (Remote)

University of Maryland Medical System Millersville Full-Time
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What You Will Do:

Coding Compliance Auditor 

Accurately audits hospital Inpatient, Ambulatory Surgery, Observation, and any other outpatient encounter visit for the purpose of appropriate reimbursement, research and compliance with federal and state regulations according to established ICD-10-CM/PCS coding and/or CPT-4 procedure coding classification systems.

Principal Responsibilities and Tasks

The following statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all job duties performed by personnel so classified.

1. Serves as a clinical coding subject matter expert, and utilizes critical thinking to analyze and evaluate documentation issues with consultation from the medical and clinical staff, and clinical documentation specialists as needed.
a. Audits ICD-10 diagnostic codes and CPT-4 procedure codes to outpatient, ambulatory surgery, and observation visits for the purpose of reimbursement, research and compliance with federal and state regulations.
b. Audits complex inpatient cases such as trauma, rehab, neurology, critical care, etc. utilizing the ICD-10-CM and ICD-10-PCS nomenclature to ensure accurate APR-DRG/SOI/ROM and POA assignment.

2. Serves in an advisory and educator role for Coding Specialists. Serves as communicator between Clinical Documentation Specialists and Coding. Researches new surgical procedures and technology. Provides training to new employees
a. Reports coding quality accuracy rate for each coder
b. Monitors productivity rate for each coder
c. Conducts specialized focused audits as needed.

3. Communicates with various departments within the hospitals regarding coding accuracy. Refers any problems to management timely, providing clear details. Assist coding specialists in writing appropriate coding queries, works collaboratively with CDI, understand Potentially Preventable Complications (PPC’s)/Maryland Hospital Acquired Conditions (MHAC’s), Prevention Quality Indicators (PQI’s) and their impact and other indicators as needed.

4. Complies with AHIMA standards of ethical coding and coding compliance guidelines.

5. Demonstrates support and compliance with University of Maryland Medical System mission, vision, values statement, goals and objectives and policies. Performs other duties or projects such as coding corrections as assigned by the manager.



What You Need to Be Successful:

Education and Experience
1. High School graduate or equivalent. Formal ICD-10-CM, ICD-10-PCS, CPT-4 training. Associates or Bachelor’s degree. Education will be considered in lieu of experience.
2. Minimum of two years ICD-10-CM/ICD-10-PCS coding and abstracting experience with at a Level 1 Trauma hospital or 4 years of experience with coding inpatient hospital medical records. 2-3 Years Ambulatory coding experience.
3. One of the following: Certified Coding Specialist (CCS), Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), Certified Inpatient Coder (CIC)

Knowledge, Skills and Abilities

Strong analytical and organizational skills; filing systems; ability to prioritize workloads; meet deadlines and work effectively under pressure; excellent customer service skills; general office procedures; ability to problem solve and work with minimal supervision; familiar with basic medical terminology; computer experience; typing ability.


We are an Equal Opportunity/Affirmative Action employer.  All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected veteran status, age, or any other characteristic protected by law.
 

Skills required

Medicare
Credentialing
Medicaid
Medical Management
Managed Care
Medical Necessity
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Job ID: 68564

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The University of Maryland Medical System (UMMS) was created in 1984 when the state-owned University Hospital became a private, nonprofit organization. It has evolved into a multi-hospital system with academic, community and specialty service missions reaching every part of the state and beyond.

UMMS is a national and regional referral center for trauma, cancer care, neurocare, cardiac care, women's and children's health and physical rehabilitation. It also has one of the world's largest kidney transplant programs, as well as scores of other programs that improve the physical and mental health of thousands of people daily.

The Medical System generates nearly $3.5 billion in economic activity in Maryland. It has 15,000 employees, approximately 2,300 licensed beds, 115,000 annual patient admissions and gross patient revenues of $2 billion.

Member Hospitals

The hospitals and health systems that comprise UMMS are:

    University of Maryland Medical Center- One of the nation's oldest teaching hospitals, this 816-bed facility -- located in downtown Baltimore -- is home to the University of Maryland Marlene and Stewart Greenebaum Cancer Center, the R Adams Cowley Shock Trauma Center, the University of Maryland Children's Hospital and the University of Maryland Division of Transplantation.

    University of Maryland Medical Center Midtown Campus - This 208-bed teaching hospital offers a full spectrum of health care for more than 110,000 people annually. University of Maryland Medical Center Midtown Campus has been providing superior and accessible community health care in West Baltimore and Midtown for more than a century.

    Mt. Washington Pediatric Hospital - This 102-bed pediatric and rehabilitation hospital, located in northwest Baltimore, provides specialty medical care to infants and children with complex medical needs.

   UM Baltimore Washington Medical Center - This 319-bed community hospital, located between Baltimore and Annapolis in Anne Arundel County, offers a wide variety of services and was recently named a "Top 100" hospital for intensive care outcomes by Thomson Reuters.

    UM Charles Regional Medical Center - Located in La Plata, Maryland, this 110-bed community hospital, along with an Ambulatory Surgery Center and OB/GYN Centers in Waldorf and La Plata, serve patients in Charles County and the surrounding areas of southern Maryland.

    UM Rehabilitation and Orthopaedics Institute - This 141-bed facility (formerly Kernan Hospital), located in Woodlawn, is the state's largest rehabilitation and orthopaedic hospital serving both adults and children. It also houses the University of Maryland Complementary Medicine Program.

   UM St. Joseph Medical Center - This 232-bed nonprofit, regional medical center, located in Towson, Md., became a part of the University of Maryland Medical System on December 1, 2012. It features institutes for heart, cancer and orthopaedic care, and offers a full range of clinical diagnostic and treatment services.

   UM Shore Regional Health - Shore Health System became UM Shore Regional Health on July 1, 2013, and consists of the following facilities: UM Shore Medical Center at Chestertown; UM Shore Medical Center at Dorchester and UM Shore Medical Center at Easton, as well as the UM Shore Emergency Center at Queenstown.

   Upper Chesapeake Health System - In July 2009, UMMS announced a strategic affiliation with Upper Chesapeake Health System that is expected to lead to a full merger. Upper Chesapeake Health includes Upper Chesapeake Medical Center in Bel Air and Harford Memorial Hospital in Havre de Grace. The leading health care system and largest private employer in Harford County, Upper Chesapeake Health offers a broad range of healthcare services, technology, and facilities to the residents of northeastern Maryland.

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