Tenet Healthcare INPATIENT AUDITOR, 40hrs., days in Worcester, Massachusetts

Responsible for conducting the secondary review of inpatient claims. Utilizing the 3M Audit Expert Inpatient software tool, responsible for evaluating the accuracy and integrity of coded patient diagnoses and procedures. Makes prudent recommendations for coding modification that will ensure coding reflects the accurate hospital resource utilization. Quickly identifies areas of potential vulnerabilities and determines appropriate action. Ensures timely and compliant reimbursement, maintains and assures data quality. Communicates with and educations the Inpatient Coding Staff, Clinical documentation specialists, Medical Staff, and other departmental staff concerning documentation, coding. Provides coding and reimbursement expertise to hospital departments as requested to ensure adherence to coding compliance.

Level of knowledge equivalent to that ordinarily acquired through completion of a Bachelor’s degree in Health Information Management or Associate’s degree in Health Information Management technology. High School diploma required. Medical Terminology, college level Anatomy and Physiology required. Formal training in organization, structure and conventions of ICD-9-CM and CPT required, Understanding of pathophysiology and pharmacology required.

Five years of experience in Acute Care Hospital setting, preferably tertiary care. Two to three years’ experience in coding validation five years’ experience with inpatient coding. Thorough understanding of and experience with Inpatient Prospective Payment system (IPPS) and Outpatient Prospective Payment system (OPPS). Understanding of pharmacology and pathophysiology required, Experience with 3M encoder preferred. Extensive knowledge of and experience with computer system/applications used in health information management.

Current Registration as Health Information Administrator (RHIA) or Health Information Technician (RHIT) preferred.

Current Certification as coding Specialist (CS) required,

Job: Conifer Health Solutions

Organization: Saint Vincent Hospital

Title: INPATIENT AUDITOR, 40hrs., days

Location: MA-Worcester

Requisition ID: 1805028850