Hospital Coding Auditor

Overview Ardent Health Services (AHS) is a national health care services company headquartered in Nashville, TN. Through its subsidiaries, Ardent owns and operates nearly 200 sites of care. Our subsidiaries own and operate hospitals and multispecialty physician practices in six states. Ardent includes 30 hospitals, 4,423 patient beds, 23,000 employees, and 1,700 employed physicians. Within the industry, we are noted for recognizing that every hospital is as unique as the community it serves. This in-depth understanding of how health care works at the local level is one of our great strengths. POSITION SUMMARY The Hospital Coding Auditor performs in depth audits of hospital (inpatient and outpatient) claims for compliance with federal and state coding regulations and guidelines. Responsibilities Perform in-depth quality assurance audits of hospital (inpatient and outpatient) claims to support ICD-10-CM and ICD-10 PCS codes and MS-DRG and APR-DRG assignments and/or CPT-4 and APC assignments, based on clinical documentation Audit patient records, reviewing diagnosis and procedures for coding compliance with local, state, federal coding regulations and guidelines Identify occurrences of "over" or "under" coding of patient records Identify potential documentation issues Prepare detailed reports on audit findings Present audit findings, education, and trends to physicians, coders, and/or other facility professionals on a monthly, quarterly and/or yearly basis Serve as an expert in Outpatient Prospective Payment System and/or Inpatient Prospective Payment System. Create consistency and efficiency in outpatient or inpatient claims processing and data collection to optimize APC, ASC or DRG reimbursement. Assists management with training new Coders or Clinical DRG Auditors to include daily monitoring, mentoring, feedback and education. Qualifications Education & Experience: High school diploma. Associate's degree, preferred. Active RN license, preferred. One of the following coding certifications required: RHIA, RHIT, CCS, CIC, CCDS, CDIP or CPC. 3 years of MS DRG/APR DRG coding or auditing experience with expert knowledge of ICD-10 Official Coding Guidelines and DRG reimbursement methodologies. Epic experience required. Clinical experience in an inpatient hospital setting, preferred. Knowledge, Skills & Abilities: Expert knowledge of ICD -10-CM coding including but not limited to; expert knowledge of principal diagnosis selection, complications/comorbidities (CCs) and major complications/comorbidities (MCCs), and conditions that impact severity of illness (SOI) and risk of mortality (ROM) Expert knowledge of ICD-10-PCS coding methodologies, code sequencing, and discharge disposition in accordance with CMS requirements, Official Guidelines for Coding and Reporting, and Coding Clinic guidance Ability to apply clinical review judgment to make clinical determinations Proficiency in computer skills and typing, i.e., Microsoft Windows, Outlook, Excel, Word, PowerPoint, Internet browsers and in virtual meeting tools i.e., Microsoft Teams, Zoom, etc.