Coder-Coding Compliance Auditor

29 سبتمبر، 2022

0 5 3 دقائق

الوصف الوظيفي

Description Position at Kanad Hospital

Kanad Hospital (formerly known as Oasis Hospital) was established in 1960 by Doctors Pat and Mariam Kennedy at the request of HH Sheikh Zayed Al Nahyan. The Kennedys were physicians from the United States whose primary goal was to honor God by providing loving healthcare to those in this region. Ever since our launch, Kanad has been known for its excellent obstetric and pediatric care, and we are proud to be recognized as one of the premier healthcare providers for women and children in the Middle East. We are honored to be the birthplace of many of the leaders of our great nation including HH Sheikh Mohamed bin Zayed Al Nahyan.

Kanad Hospital is a not-for-profit hospital that strives to diligently follow the teachings of Jesus in the way that we care for women, children, and their families. We have the privilege of being the first hospital established in the Abu Dhabi Emirate and the first private hospital in the Emirate to attain JCI accreditation. Additionally, we are the first hospital in the world to obtain JCI Clinical Care Program Certifications for our treatment program for Respiratory Distress Syndrome in newborns and for our Natural Birth after Cesarean Section program for mothers.

Hope: Healthy communities transformed by the love of the God.
Purpose: To honor God by providing exceptional whole person healthcare to the community with the love and compassion of Jesus Christ.
Job Title: Coding Compliance Auditor

Position Summary: Coding Compliance Auditor is responsible for performing an in-depth review of selected Inpatient and Outpatient medical records to ensure that the assigned codes are supported by clinical documentation and all diagnoses and procedures are coded with the required specificity.

Requirements:

Education: Degree in any related field preferably life science background. CCS (AHIMA) or CPC (AAPC) certification is required.
Duration and type of Experience: Minimum of five (5) years coding experience in any setting with minimum of 2 years auditing experience i.e., hospital, clinic, home health, or other related healthcare field is required. In addition to medical coding, knowledge of billing process will be a plus. Both inpatient and outpatient experience preferred.

Job functions and Key Accountabilities:

Ensure coding and billing compliance through ongoing audits and education of coding staff, nurses, physicians, denial prevention specialist and pre-authorization coordinators.
Under general supervision, using a combination of DOH claims and adjudication rules, coding and clinical documentation knowledge, the coding compliance auditor will complete scheduled audits of assigned providers and coders at designated intervals.
Prepares various reports, including audit summary reports for the Physicians, coders and Director RCM.
Expertise in assigning accurate ICD-9-CM, CPT, DRG, HCPCS and other service codes for diagnosis and procedures performed in both Inpatient and Outpatient setting.
Applying advanced knowledge of medical terminology , anatomy and physiology, treatment modalities , diagnostic test, medications
Providing orientation and coding education to coders, pre-authorization co-coordinators, denial prevention specialist, physicians and nurses regarding documentation and query physicians effectively to ensure better documentation.
Aware of current trends related to medical necessity, DRG and DOH Claims and Adjudication rules and coding guidelines
Acts as a resource when necessary for billing, pre-authorization and reimbursement issues and coding.
Excellent interpersonal skills while interacting with physicians, nurses and other staffs.
Ensure high level of patient data confidentiality.
Utilizes tools available in 3M to ensure accurate coding.
Ensure knowledge on deductibles, co-payments, co-insurance amounts, insurance exclusions and other policies of all insurances that Kanad Hospital is dealing with.
Critical thinker with ability to perform root cause analysis, prepare and implement action plans and lead improvement initiative.
Appropriate selection of principal diagnosis, qualifying secondary diagnosis, Impacting procedures, accurate E/M and others services which is relevant for submission and reimbursement.
Ensures to reduce rejections and get the claim paid at the initial submission or resubmission of claims.
Perform other related duties incidental to the work described herein.

Technical Competencies:

Audits medical record documentation to identify down coded and up coded services; prepares reports of findings and meets with providers and coders to provide education and training on accurate coding practices and compliance issues.
Interacts with physicians and obtains clarification of conflicting, ambiguous, or non-specific documentation and query effectively to ensure better documentation
Responsible for mentoring and training other coders to ensure high level of accuracy.