Coding Auditor (ICD-10)

Location: Newark, New Jersey, United StatesCompany: Integrated ResourcesPosted: Coding Auditor (ICD-10) Position: Coding Auditor (ICD-10) Duration: Full-Time Location: Newark/Wall NJ Job Summary: This position is responsible for conducting on site audits of hospital billing and coding practices and desk audits; forms development, profiling and tracking institutional audit trends. Performs and finalizes multiple per diem, bill verification, DRG Validation (utilization review audits) and credit balance. Additionally provides guidance/instruction to various stakeholders on ICD9-CM, ICD-10, DRG assignment payment and auditing.

Responsibilities: • Identifies and presents billing discrepancies found during audit and coordinates referral of improper claim payments through the appropriate channels. • Identifies error trends as they relate to medical record and or billing documentation or misinterpretation of provider contract stipulations. • Compiles statistics and other audit information to present to accounts, regulatory agencies, and internal requesters. • Reviews and updates audit processes with manager for purposes of keeping up with new innovations in clinical data review and company cost containment initiatives. • Required to train new staff on department/audit procedures. • Performs other special assignments as requested by manager. • Demonstrates knowledge, understanding and conforms to laws, regulations and policies that pertain to the organizational units business. Knowledge: • Requires knowledge of medical terminology, detailed knowledge of anatomy & physiology, disease pathogenesis and treatment including procedural drug therapies, ancillary and diagnostic services. • Requires knowledge of principles of utilization management. • Requires knowledge of hospital structures and payment systems. • Requires knowledge of Centers of Medicare and Medicaid prospective payment system regulations. • Prefers knowledge of ACCESS Software. • Must have effective verbal and written communication skills and demonstrate the ability to work well within a team. Demonstrated ability to deliver highly technical information to less technical individuals. • Must have strong PC skills experience with MICROSOFT office programs: excel, word and power point. • Must demonstrate professional and ethical business practices, adherence to company standards, and a commitment to personal and professional development. • Proven time management skills are necessary. Must demonstrate the ability to manage multiple priorities (or tasks), deliver timely and accurate work products with a customer service focus, and respond with a sense of urgency as required. Demonstrated ability to work in a production focused environment. • Proven ability to ask probing questions and obtain thorough and relevant information. • Needs to demonstrate willingness to cross-train, and be cross-trained, in other roles/duties. • Must be detail oriented with strong organizational and data processing skills. Proven ability to follow detailed instructions is essential, along with proven problem solving skills. • Proven analytical, research and problem solving skills a must.

Qualifications Education: • Requires a Bachelor's degree in Health Information Management or related field; or a RN with CCS certification.

Experience: • Requires a minimum of 3 years of experience in a medical records department of an acute care hospital or other health care facility.

Experience with DRG validation, ICD-9-CM or ICD-10 training and education. Additional licensing, certifications, registrations: • Requires RHIA or RHIT certification; or RN with CCS certification. • Valid Driver's license and access to a car.