SENIOR MEDICAL AUDIT ANALYST

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The impact of the coding function on data collection, reimbursement and accreditation of the medical center is significant. Submission of quality data as required by State and National regulatory and accrediting bodies has major impact on MMC reputation and prominence in the health care industry.
The Sr. Medical Audit Analyst is responsible for the accuracy, consistency and quality of coding and data collection using recognized disease and procedure coding classifications (ICD-10, ICD-O, CPT- 4 HCPCS etc.) The SMA mus understand the role of coding and data collection on disease and epidemiological research public health programming, patient care improvement and on billing and reimbursement. the SMAA must evaluate correct sequencing of codes evaluate reason for edits and correct and update as required; understand disease morphology, staging conventions, surgical interventions and treatment modalities.
Conduct performance improvement activities regarding coding accuracy, completeness, data quality and integrity; identify issues in correct sequencing of codes, staging and grouping payment methodology
Collaborate with physician, nursing and other clinical staff and review agencies on survey requirements, responses to denials, and other issues and to obtain clarification on documentation of clinical care.
Provide guidance and coaching to staff as required.

QUALIFICATIONS:

• High School Diploma or GED required

• Associated Degree preferred

• 3 years of work experience required

• Training and experience in applying various coding classifications and grouper methodologies and staging conventions.

• Candidates for this position in HIM Coding must have satisfactorily completed a course in Coding using ICD -10CM, ICD-10 PCS and CPT4 and other applicable disease and procedure coding classifications AND must have experience coding, reviewing and abstracting records for patients in all levels of care in a complex health care environment such as Montefiore.

• Certification required RHIA RHIT CCS /CCS-P /CPC

• Candidates for a position in the Cancer Registry must have completed a course in Cancer Registry operations and coding , abstracting and staging techniques using ICD-O. These candidates must demonstrate knowledge in use of ICD-O and staging methodologies .

• Certification as CTR / ODS required within 1yr of hire

• Two (2)years related experience. Experience in HIM preferred.
  Candidates must demonstrate knowledge of coding techniques and be familiar with reviewing medical records in an electronic environment.

• Critical thinking and excellent communication skills
  Satisfactory equivalent of Education, Knowledge and Experience