Copyright 2021 Cook Children's Health Care System, Fort Worth, Texas
In collaboration with the Clinical Documentation Specialists (CDI), Quality Improvement team and HIM Coding staff, the CDI/Coding Compliance Auditor will perform a variety of audits related to documentation accuracy and specifically, coding accuracy & APR-DRG assignment compliance. Analyzes and evaluates patient care documentation after coding and before billing assigns codes as needed, ensures accuracy of Present on Admission status (POA) and DRGs to validate the documentation supports code specificity per compliance requirements. Performs Pre-bill Audit reviews (PBA) reviews, tracks, trends and reports audit results from the APR-DRG auditors and CDI teams. Provides feedback and education regarding opportunities for documentation improvement to physicians, coders and the CDI team. Provides expertise in ICD coding, DRG assignment, documentation guidance and education and assists in setting goals and priorities for the CDI team. Review coding denials for appropriate and accurate coding. Assists the CDI Manager and team in creation of documentation clarification queries requesting providers to provide additional documentation. Functions as the liaison between the CDI team, Coding staff, Physician Advisors and Providers. Communicates with and educates Physician Advisors and providers regarding areas committees on a monthly or as requested basis. Fosters relationships between all disciplines. Maintains current and thorough knowledge and understanding of clinical documentation improvement, Epic systems, coding schemes, APR-DRG groupers, Cook’s policies, procedures, regulatory requirements and guidelines for documentation, coding and billing/reimbursement.
Education & Experience:
Licensure, Registration, and/or Certification:
Registered Health Information Administrator (RHIA) or Registered Health Information Technologist (RHIT) with Certified Coding Specialist (CCS) required.
Certified Clinical Documentation Specialist (CDI) highly desired.
ICD-10-CM/PCS training highly desired.
***Remote within the State of Texas***