About Us:
Our purpose is to help clients exceed their financial health goals. Across the reimbursement cycle, our scalable solutions and clinical expertise help solve programmatic needs. Enabling our teams with leading technology allows analytics to guide our solutions and keeps us accountable achieving goals.
We build long-term careers by investing in YOU. We seek to create an environment that cultivates your professional development and personal growth, as we believe your success is our success.
JOB SUMMARY:
Serves in a consulting role by evaluating the work of client coding professionals in their assignment of ICD-10-CM and ICD-10-PCS codes for hospital inpatient encounters. Performs concurrent and/or retrospective reviews to validate code assignment accuracy, identify documentation and coding trends, and report findings to clients. Develops and delivers educational content to clients based on audit results and identified opportunities for improvement.Extensive experience with MS/APR DRG assignment, ensuring accurate selection of principal and secondary diagnoses, PCS, POA indicators and physician query initiation.
Requirements/Highlights:
This position requires extensive experience in Inpatient (facility) auditing
Experience with MS-DRG and PCS review, POA, query opportunities, principal and secondary diagnosis assignment
Fully remote - FT 40 hrs/week - Salary PLUS benefits!
ESSENTIAL DUTIES AND RESPONSIBILITIES:
Note: The essential duties and responsibilities below are intended to describe the general duties and responsibilities of this position and are not intended to be an exhaustive statement of duties. This position may perform all or most of the primary duties listed below. Specific tasks, responsibilities or competencies may be documented in the Team Member’s performance objectives as outlined by the Team Member’s immediate Leadership Team Member.
Essential Functions:
Note: The essential duties and primary accountabilities below are intended to describe the general
content of and requirements of this position and are not intended to be an exhaustive statement of
duties. Incumbents may perform all or most of the primary accountabilities listed below. Specific tasks, responsibilities or competencies may be documented in the incumbent’s performance objectives as outlined by the incumbent’s immediate supervisor or manager.
- Perform complex concurrent and/or retrospective analysis of inpatient medical record documentation to validate coded data in accordance with AHA, CMS, AHIMA, Coding Clinic, and official ICD-10 guidelines.
- Analyze findings and identify potential root causes of produced errors.
- Prepare summary reports of findings to clients, supplying specific references supporting findings contained within the provided audit report.
- Provides second-level review of processes to ensure compliance with legal and procedural policies and to ensure appropriate code assignments.
- Research, analyze, and respond to inquiries regarding compliance, coding, and denials.
- In all situations, protect the privacy and confidentiality of patient health and client information, and follow the Standards of Ethical Coding as set forth by AHIMA and adhere to official coding guidelines and compliance practices, standards, and procedures.
- Functions as a member of the Consulting Services Team which develop and provide coding guidance to clients.
- Conduct Audits as assigned meeting the productivity standards as set by record type for each audit. The threshold for billable productive hours, when client work is available, is expected to be at or above 80%.
- Prepare deliverables for the client as required for the audit scope while meeting timelines.
- Conduct independent QA of their assigned audit results prior to final submission for QA review and approval. The minimum accuracy expectation is 95%.
- Report work time and work products in a timely and accurate manner.
- Communicates with coworkers in an open and respectful manner that promotes teamwork and knowledge sharing.
- Interact with clients in a professional manner that, always, exhibits excellent relationships, work performance and communication skills so as to support the company and its business interests.
- Provide schedule of planned work activities, events and sites, and any changes to same, to Management and appropriate staff.
- Maintenance of professional credentials and knowledge of coding, reimbursement, and compliance issues through continuing education.
- Periodic travel, as applicable.
- Other duties and responsibilities, as assigned.
Knowledge, Skills & Abilities:
- Active AHIMA or AAPC credential (e.g., CCS, RHIA, RHIT).
- Minimum 5 years of inpatient coding and/or auditing experience in an acute care hospital or equivalent consulting environment.
- Demonstrated understanding of inpatient reimbursement methodologies, regulatory compliance, and audit best practices.
- Strong analytical, problem-solving, and critical-thinking skills.
- Proficient computer skills, specifically Microsoft Office Products.
- Ability to translate complex regulatory requirements into clear, client-focused guidance.
- Proficiency with multiple electronic health records (e.g., EPIC, Powerchart, Meditech etc.)
- Strong written and verbal communication skills suitable for executive-level and operational audiences.
- Ability to manage multiple client engagements independently while meeting quality and productivity expectations.
- High attention to detail with a commitment to accuracy and ethical practice.
- Collaborative, consulting-oriented mindset with the ability to work effectively in a remote environment.
Physical Requirements and Demands:
Note: Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions as described.
Regular eye-hand coordination and manual dexterity is required to operate office equipment. The ability to perform work at a computer terminal for 6-8 hours a day and function in an environment with constant interruptions is required. At times, incumbents are subject to sitting for prolonged periods. Infrequently, incumbent must be able to lift and move material weighing up to 20 lbs. Incumbent may experience elevated levels of stress during periods of increased activity and with work entailing multiple deadlines.
PHYSICAL DEMANDS:
Note: Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions as described. Regular eye-hand coordination and manual dexterity is required to operate office equipment. The ability to perform work at a computer terminal for 6-8 hours a day and function in an environment with constant interruptions is required. At times, Team Members are subject to sitting for prolonged periods. Infrequently, Team Member must be able to lift and move material weighing up to 20 lbs. Team Member may experience elevated levels of stress during periods of increased activity and with work entailing multiple deadlines.
A job description is only intended as a guideline and is only part of the Team Member’s function. The company has reviewed this job description to ensure that the essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.