Coding Auditor Specialist

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A Brief Overview

Reporting to the Coding Operations and Compliance Manager, the Coding Auditor Specialist plays a key role in ensuring the accuracy and integrity of our coding processes. In this role, you'll review inpatient and outpatient coded accounts to confirm that diagnoses, procedures, and DRG assignments are complete, accurate, and fully supported by documentation. Your expertise helps ensure appropriate reimbursement and reflects the true complexity of our patients' care.

You'll bring a strong working knowledge of MS-DRG, APR-DRG, ICD-10-CM/PCS, CPT, and HCPCS, along with a passion for quality and compliance. This position offers an opportunity to make a meaningful impact on both operational excellence and patient care documentation.

What you will do

Coding Audit & Compliance

• Perform pre-bill reviews of coded accounts to validate code assignment and identify missed opportunities or inaccuracies.
• Conduct retrospective reviews of high-risk coding areas and regularly scheduled audits for compliance with: Official Coding Guidelines, CHOP internal guidelines, AHA Coding Clinic for ICD-10 HCPCS, CPT-4, and AMA CPT Assistant
• Audit records to identify documentation improvement opportunities related to:
  Severity of Illness (SOI)
  Risk of Mortality (ROM)
  APR-DRG and/or MS-DRG
  APC
  ICD-10-CM/PCS
  CPT-4 and HCPCS
• Assist in the review of Hospital-Acquired Conditions (HACs) and other quality indicators for appropriateness.
• Identify anomalous coding or query practices and escalate to leadership.
• Education & Subject Matter Expertise
• Serve as a subject matter expert for coding practices and guidelines.
• Provide education to physicians, clinical documentation specialists, and coders based on audit findings and trends.
• Recommend and deliver targeted education based on identified coding or documentation trends.
• Stay current with all coding, documentation, and query guidelines and regulatory changes.

Reporting & Analysis

• Organize and report audit findings regularly to leadership.
• Identify and communicate coding issues and trends to leadership.
• Recommend areas for education and process improvement.
• Track audit outcomes and maintain documentation for compliance and quality assurance.

Collaboration & Departmental Support

• Collaborate with CDI specialists, providers, and billing teams to resolve discrepancies and improve documentation.
• Adhere to all internal policies, procedures, and guidelines of the Coding and Clinical Documentation Integrity department.
• Set goals and prioritize work using available resources efficiently and effectively.
• Participate in Quality Improvement initiatives and represent the Coding team on relevant committees.

Training & Documentation

• Develop and maintain standardized orientation training for coding and documentation.
• Track training completion metrics and escalate unmet training needs.
• Create enterprise documentation tip-sheets in collaboration with other stakeholders.
• Track recurring deficiencies and recommend EMR template updates.

Education Qualifications

• Associate's Degree Health Information Management or related field - Required
• Bachelor's Degree Health Information Management or related field - Preferred

Experience Qualifications

• At least five (5) years inpatient and outpatient coding experience - Required
• At least two (2) years experience performing coding audits - Preferred

Skills and Abilities

• Ability to lead a team for projects. (Required proficiency)
• Advanced knowledge of complex surgical coding. (Required proficiency)
• Advanced knowledge of ICD-10-CM and ICD-10-PCS. (Required proficiency)
• Advance knowledge of the APR-DRG system. (Required proficiency)
• Knowledge of the MS-DRG system. (Required proficiency)
• Knowledge the revenue cycle functions. (Required proficiency)
• Experience with encoder software such as 3M CRS and/or 3M 360 CAC. (Required proficiency)
• Familiarity with electronic health records (EHR), preferably Epic experience. (Required proficiency)
• Proficiency with Microsoft Office products such as Microsoft Office and Excel. (Required proficiency)
• Excellent verbal and written communications skills. (Required proficiency)
• Excellent interpersonal skills. (Required proficiency)
• Strong critical thinking / problem-solving skills. (Required proficiency)
• Strong analytical skills. (Required proficiency)
• Ability to maintain confidentiality and professionalism. (Required proficiency)
• Ability to work independently with minimal supervision. (Required proficiency)
• Ability to gather, analyze and make recommendations/decisions based on data. (Required proficiency)
• Ability to convey complex or technical information in an easy-to-understand manner. (Required proficiency)

Licenses and Certifications

• Registered Health Information Technician (RHIT) - American Health Information Management Association - upon hire - Required or
• Registered Health Information Administrator (RHIA) - American Health Information Management Association - upon hire - Required
• Certified Coding Specialist (CCS) - American Health Information Management Association - upon hire - Preferred or
• Certified in Healthcare Privacy and Security (CHPS) - American Health Information Management Association - upon hire - Preferred

To carry out its mission, CHOP is committed to supporting the health of our patients, families, workforce, and global community. As a condition of employment, CHOP employees who work in patient care buildings or who have patient facing responsibilities must receive an annual influenza vaccine. Learn more.

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SALARY RANGE:

Salary ranges are shown for full-time jobs. If you're working part-time, your pay will be adjusted accordingly.

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At CHOP, we are committed to fair and transparent pay practices. Factors such as skills and experience could result in an offer above the salary range noted in this job posting. Click here for more information regarding CHOP's Compensation and Benefits.