Coding Auditor - DRG/APC Coordinator

The Coding Auditor - DRG/APC Coordinator is responsible for ensuring accuracy and quality of coding assignments for all records requiring DRG and/or APC coding, and ensures optimal and timely reimbursement. Performs data quality reviews on inpatient and outpatient records to ensure proper coding guidelines have been followed and appropriate DRG or APC assignments have been made for appropriate reimbursement. Provides DRG/APC and coding quality information and statistical reports to the Coding Manager. Communicates with the Medical Staff and House staff as needed to discuss clinical questions with respect to the assignment of ICD-10-CM and ICD-10-PCS codes for diagnoses and procedures. Educates the Medical Staff and House staff regarding the importance of sufficient documentation to support the assignment of the appropriate DRG/APC. Reviews Hospitals' specific coding guidelines and procedures and suggests changes and updates to the Coding Manager. Participates in team meetings with coding personnel to discuss coding problems, changes, or issues. Performs routine coding and abstracting as directed. Utilizes 3M encoder optimizing function to review data for accuracy. Reviews PRO coding changes, reports findings to the Coding Manager, and provides appropriate documentation to the PRO when appealing a PRO decision. Maintains accreditation with AHIMA and abides by the Standards of Ethical Coding as set forth by the AHIMA. Remains current on all PRO, OIG and IPPS/OPPS rules and regulations, coding updates, changes and issues.