Medical Coding Auditor

Responsibilities and Duties

• Applies comprehensive knowledge of medical terminology, anatomy & physiology, disease processes, treatment modalities, diagnostic tests, medications, procedures as well as the principles and practices of health services and the organizational structure to ensure proper code selection.
• Reviews assigned codes from the current version of several coding systems to include current versions of the International Classification of Diseases (ICD), Current Procedural Terminology (CPT), and/or Healthcare Common Procedure Coding System (HCPCS).
• Applies guidelines specific to certain diagnoses, procedures, and other criteria used to classify patients under the Veterans Equitable Resource Allocation (VERA) program that categorizes all VA patients into specific classes representing their clinical conditions and resource needs.
• Monitors ever-changing regulatory and policy requirements affecting coded information for the full spectrum of services provided by the VAMC.
• Assists facility staff with documentation requirements to completely and accurately reflect the patient care provided.
• Reviews, analyzes, and reports performance monitors for PTF, PCE, VERA and Non-VA Medical Care (purchased care) coding.
• Performs other duties as assigned.

Required Skills and Abilities

• Audit accurate and complete assignment of ICD-10-CM and ICD-10-PCS codes, MS-DRG, POA status, and discharge disposition values for inpatient health records.
• Facilitates improved overall quality, completeness, and accuracy of coded data. Ensures the accuracy and completeness of clinical information used for measuring and reporting physician and medical center outcomes with continuing education to all members of the patient care team on an ongoing basis.
• Responsible for performing audits of coded data, developing criteria, collecting data, graphing, and analyzing results, creating reports, and communicating in writing and/or in person to appropriate leadership and groups.
• Collaboratively works with coding staff and clinical staff to provide support and education on coding issues. Provides training and education to coding and clinical staff. Research complex coding issues and participates in process improvements related to coding.
• Analyze audit results and prepare summary feedback for individual coders and/or clinicians, making recommendations for improvement. Provide coding consultation to coders and/or clinicians related to coding and documentation questions.
• Requires six additional months of creditable experience that is paid or non-paid employment equivalent to a MRT (Coder).

Education and Experience

Certifications Required

Physical Requirements

• Prolonged periods of sitting at a desk and working on a computer