At Houston Methodist, the Coding Quality Auditor position is responsible for ensuring accuracy in code assignment of diagnosis and procedure to outpatient and/or inpatient encounters based upon documentation within the electronic medical record while maintaining compliance with established rules and regulatory body guidelines. This position performs data quality review to ensure data integrity, coding accuracy, and revenue preservation. Additional duties include participating in quality review and performance improvement projects throughout the department and/or facility.
PEOPLE ESSENTIAL FUNCTIONS
- Interacts and communicates effectively with members of the coding team and HIM, physicians, CDMP nurses, IT, Quality Operations, Case Management, Patient Access and Business Office.
- Participates and provides good feedback during coding section meetings, coding education in-services, and coder/CDMP meetings. Takes initiative to assist others and shares knowledge with the coding group and business partners on official coding guidelines.
SERVICE ESSENTIAL FUNCTIONS
- Responds promptly to internal and external customer coding/DRG requests. Responds promptly to Business Office requests to code or review coded accounts for accuracy. Identifies and anticipates customer requirements, expectations, and needs. Provides assistance to the leadership team or other coders with coding of the accounts or answering questions from other coders relating to coding and work flows.
- Initiates queries with physicians to obtain or clarify diagnoses and/or procedures as appropriate, utilizing the established physician query process. Provides assistance to Clinical Documentation Management Program (CDMP) with appropriate MS-DRG and APR-DRG assignment, sequencing of diagnoses and procedures, and coding and documentation training.
- Assists with quality assurance (peer) reviews to ensure data integrity and accuracy of coding, identifies opportunities for improvements, and makes recommendations for optimal enhancements.
- Assists Case Management and Patient Access Departments in providing appropriate CPT codes for pre-admission and pre-certification requirements including the inpatient only process. Assists in the development of documentation protocols for physicians. Represents the coding area in Hospital meeting/events when necessary (e.g., Performance Improvement Committees).
QUALITY/SAFETY ESSENTIAL FUNCTIONS
- Maintains and achieves the highest standards of coding quality by assigning accurate ICD-9-CM/ICD-10-CM/ICD-10-PCS and CPT codes utilizing an electronic encoder application in accordance with hospital policy and regulatory body guidelines.
- Performs accurate, optimal DRG and APC assignment, in accordance with nationally established rules and guidelines based upon documentation within the medical record.
- Reviews discharge disposition entered by nursing and corrects if necessary in order to achieve the highest quality of entered data.
- Assigns and enters physician identification number and procedure date correctly in the medical record abstracting system. Reviews medical record documentation and abstracts data into the encoder and Electronic Health Record (EHR) abstracting system to determine principal or final diagnosis, co-morbid conditions and complications, secondary conditions and procedures.
- Assists with quality reviews of outpatient or inpatient accounts and/or training of new coders. Complies with the Standards of Ethical Coding as set forth by the American Health Information Management Association (AHIMA) and adheres to official guidelines.
- Aggregates data from reviews and compiles reports for HIM management.
FINANCE ESSENTIAL FUNCTIONS
- Utilizes time effectively. Consistently codes and abstracts at departmental standards of productivity while ensuring accuracy of coding. Ensures work flows and worklists are reviewed or monitored in order to identify old uncoded accounts or problem accounts.
- Assists in making sure coding bill hold goal is met. Maintains coding timeframes within acceptable guidelines by ensuring all work items assigned to the coding queues and worklists are processed in a timely manner.
GROWTH/INNOVATION ESSENTIAL FUNCTIONS
- Critically evaluates her or his own performance, accepts constructive criticism, and looks for ways to improve. Displays initiative to improve relative to job function. Contributes ideas to help improve quality of coding data and abstracting data.
This job description is not intended to be all-inclusive; the employee will also perform other reasonably related business/job duties as assigned. Houston Methodist reserves the right to revise job duties and responsibilities as the need arises.
EDUCATION
- Associate's degree or higher in a Commission on Accreditation in Health Informatics and Information Management accredited program required or additional two years of experience (in addition to the minimum experience requirements listed below) required in lieu of degree.
WORK EXPERIENCE
- Five years of coding experience relevant to the area auditing (e.g., inpatient, outpatient, professional fee).
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