Auditor III- DRG Coding Auditor

EXL/SCIO Health Analytics is looking for DRG Coding Auditors who are excited about the growing fields of Analytics and who would like to join an amazing team! This is a Home Office opportunity.

 

The responsibilities of the DRG Coding Auditor is to perform DRG reviews by validating accuracy of the DRG or APR DRG code assignment completeness, POA, discharge status, etc to ensure accurate payment by our clients. The coding auditor determines if a discrepancy exists in the coding and documents the findings using standard documentation guidelines applicable to the program. The audits can be done as desk or as onsite in which case the coding auditor might have to travel to the providers location on an agreed upon schedule and perform the audit review.

Reviews medical records and coding to validate clinical coding

Ability to write professional finding notes based on SCIO policies using official coding guidelines, ICD-10 coding handbook, coding clinic or other recognized sources

Enters all required DRG review information into encoder program to obtain validated DRG

Identifies questionable encoder results and reviews with program manager

Takes responsibility for updating status of audit in the audit workflow system

Schedules and performs onsite audits in accordance with the program policies and procedures

Works independently

Needs to meet established program productivity and quality goals

Escalates facility issues to manager for resolution

Review appeal information and render coding decision to either uphold or overturn original finding

Participate in Inter Rater Reliability quality reviews

Comply with all SCIO Employee Handbook policies and procedures

Comply with HIPAA and other regulations regarding confidentiality of information

Adhere to established SCIO Audit Policies and Procedures

Perform other duties as assigned.

· Minimum High School Diploma 

· CCS or CPC 

· Two years inpatient hospital coding experience 

· Good verbal and written communication skills

 

Preferred:

· 5 years DRG Auditing experience 

· RHIT or RHIA Certification 

· Clinical Documentation Specialist (CDS)