Coding Quality Auditor

At Houston Methodist, the Coding Quality Auditor position is responsible for ensuring accuracy in code assignment of diagnosis and procedure to outpatient and/or inpatient encounters based upon documentation within the electronic medical record while maintaining compliance with established rules and regulatory body guidelines. This position performs data quality review to ensure data integrity, coding accuracy, and revenue preservation. Additional duties include participating in quality review and performance improvement projects throughout the department and/or facility.

PATIENT AGE GROUP(S) AND POPULATION(S) SERVED
Refer to departmental "Scope of Service" and "Provision of Care" plans, as applicable, for description of primary age groups and populations served by this job for the respective HM entity.

HOUSTON METHODIST EXPERIENCE EXPECTATIONS

• Provide personalized care and service by consistently demonstrating our I CARE values:
  • INTEGRITY: We are honest and ethical in all we say and do.
  • COMPASSION: We embrace the whole person including emotional, ethical, physical, and spiritual needs.
  • ACCOUNTABILITY: We hold ourselves accountable for all our actions.
  • RESPECT: We treat every individual as a person of worth, dignity, and value.
  • EXCELLENCE: We strive to be the best at what we do and a model for others to emulate.

• Practices the Caring and Serving Model

• Delivers personalized service using HM Service Standards

• Provides for exceptional patient/customer experiences by following our Standards of Practice of always using Positive Language (AIDET, Managing Up, Key Words)

• Intentionally collaborates with other healthcare professionals involved in patients/customers or employees' experiential journeys to ensure strong communication, ease of access to information, and a seamless experience.

• Involves patients (customers) in shift/handoff reports by enabling their participation in their plan of care as applicable to the given job

• Displays cultural humility, diversity, equity and inclusion principles

• Actively supports the organization's vision, fulfills the mission and abides by the I CARE values

PEOPLE ESSENTIAL FUNCTIONS

• Interacts and communicates effectively with members of the coding team and HIM, physicians, CDMP nurses, IT, Quality Operations, Case Management, Patient Access and Business Office.

• Participates and provides good feedback during coding section meetings, coding education in-services, and coder/CDMP meetings. Takes initiative to assist others and shares knowledge with the coding group and business partners on official coding guidelines.

SERVICE ESSENTIAL FUNCTIONS

• Responds promptly to internal and external customer coding/DRG requests. Responds promptly to Business Office requests to code or review coded accounts for accuracy. Identifies and anticipates customer requirements, expectations, and needs. Provides assistance to the leadership team or other coders with coding of the accounts or answering questions from other coders relating to coding and work flows.

• Initiates queries with physicians to obtain or clarify diagnoses and/or procedures as appropriate, utilizing the established physician query process. Provides assistance to Clinical Documentation Management Program (CDMP) with appropriate MS-DRG and APR-DRG assignment, sequencing of diagnoses and procedures, and coding and documentation training.

• Assists with quality assurance (peer) reviews to ensure data integrity and accuracy of coding, identifies opportunities for improvements, and makes recommendations for optimal enhancements.

• Assists Case Management and Patient Access Departments in providing appropriate CPT codes for pre-admission and pre-certification requirements including the inpatient only process. Assists in the development of documentation protocols for physicians. Represents the coding area in Hospital meeting/events when necessary (e.g., Performance Improvement Committees).

QUALITY/SAFETY ESSENTIAL FUNCTIONS

• Maintains and achieves the highest standards of coding quality by assigning accurate ICD-9-CM/ICD-10-CM/ICD-10-PCS and CPT codes utilizing an electronic encoder application in accordance with hospital policy and regulatory body guidelines.

• Performs accurate, optimal DRG and APC assignment, in accordance with nationally established rules and guidelines based upon documentation within the medical record.

• Reviews discharge disposition entered by nursing and corrects if necessary in order to achieve the highest quality of entered data.

• Assigns and enters physician identification number and procedure date correctly in the medical record abstracting system. Reviews medical record documentation and abstracts data into the encoder and Electronic Health Record (EHR) abstracting system to determine principal or final diagnosis, co-morbid conditions and complications, secondary conditions and procedures.

• Assists with quality reviews of outpatient or inpatient accounts and/or training of new coders. Complies with the Standards of Ethical Coding as set forth by the American Health Information Management Association (AHIMA) and adheres to official guidelines.

• Aggregates data from reviews and compiles reports for HIM management.

FINANCE ESSENTIAL FUNCTIONS

• Utilizes time effectively. Consistently codes and abstracts at departmental standards of productivity while ensuring accuracy of coding. Ensures work flows and worklists are reviewed or monitored in order to identify old uncoded accounts or problem accounts.

• Assists in making sure coding bill hold goal is met. Maintains coding timeframes within acceptable guidelines by ensuring all work items assigned to the coding queues and worklists are processed in a timely manner.

GROWTH/INNOVATION ESSENTIAL FUNCTIONS

• Critically evaluates her or his own performance, accepts constructive criticism, and looks for ways to improve. Displays initiative to improve relative to job function. Contributes ideas to help improve quality of coding data and abstracting data.

This job description is not intended to be all-inclusive; the employee will also perform other reasonably related business/job duties as assigned. Houston Methodist reserves the right to revise job duties and responsibilities as the need arises.

EDUCATION

• Associate's degree or higher in a Commission on Accreditation in Health Informatics and Information Management accredited program required or additional two years of experience (in addition to the minimum experience requirements listed below) required in lieu of degree

WORK EXPERIENCE

• Five years of coding experience relevant to the area auditing (e.g., inpatient, outpatient, professional fee)

LICENSES AND CERTIFICATIONS - REQUIRED

• RHIT - Certified Health Information Technician (AHIMA) -- For inpatient/outpatient coding OR
• RHIA - Registered Health Information Administrator (AHIMA) -- For inpatient/outpatient coding OR
• CCS - Certified Coding Specialist (AHIMA) -- For inpatient/outpatient coding OR
• CCS-P - Certified Coding Specialist Physician-based (AHIMA) -- For professional fee coding OR
• CPC - Certified Professional Coder (AAPC) -- For professional fee coding

LICENSES AND CERTIFICATIONS - PREFERRED

• AHIMA ICD-10 CM/PCS Trainer

KNOWLEDGE, SKILLS, AND ABILITIES

• Demonstrates the skills and competencies necessary to safely perform the assigned job, determined through on-going skills, competency assessments, and performance evaluations

• Sufficient proficiency in speaking, reading, and writing the English language necessary to perform the essential functions of this job, especially with regard to activities impacting patient or employee safety or security

• Ability to effectively communicate with patients, physicians, family members and co-workers in a manner consistent with a customer service focus and application of positive language principles

• Knowledge of an electronic medical record and imaging systems

• Working knowledge of medical terminology, anatomy and physiology

• Proficiency with electronic encoder application

SUPPLEMENTAL REQUIREMENTS

WORK ATTIRE

• Uniform No
• Scrubs No
• Business professional Yes
• Other (department approved) No

ON-CALL*
*Note that employees may be required to be on-call during emergencies (ie. DIsaster, Severe Weather Events, etc) regardless of selection below.

• On Call* No

TRAVEL**
**Travel specifications may vary by department**

• May require travel within the Houston Metropolitan area Yes
• May require travel outside Houston Metropolitan area Yes

Houston Methodist (HM) is one of the nation’s leading health systems and academic medical centers.  HM consists of eight hospitals: Houston Methodist Hospital, its flagship academic hospital in the heart of the Texas Medical Center, and seven community hospitals throughout the greater Houston metropolitan area.  HM also includes an academic institute, a comprehensive residency program, a global business division, numerous physician practices and several free-standing emergency rooms and outpatient facilities.  Overall, HM employs over 25,000 employees.   Houston Methodist is supported by a wide variety of business functions that operate at the system level to help enable clinical departments to provide the best patient care and service in a spiritual environment.

 

In 2019 Houston Methodist and its physicians treat more than 6,333 international patients from more than 76 countries. Houston Methodist Global Health Care Services’ consulting and education divisions also provide advisory services and training and development to health care organizations around the world.