HIM Documentation Auditor
Fletcher Allen Health Care - Burlington, VT

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The HIM Documentation Auditor performs routine auditing of inpatient, outpatient, and ED visits coded by the HIM coders to ensure that all ICD-9-CM codes and CPT/HCPCS codes, as assigned, are accurate, supported by the clinical documentation in the record and in compliance with applicable coding guidelines. The HIM Documentation Auditor applies knowledge of anatomy and physiology, medical terminology and pathology of disease processes while analyzing clinical documentation of inpatient, and outpatient records. The incumbent will apply knowledge of ICD-9 and CPT-4 nomenclatures and American Hospital Association, American Medical Association and applicable Federal and third party payor guidelines to accurately and compliantly determine principal and secondary ICD-9 diagnosis codes, principal and secondary ICD-9 procedure codes and all relevant CPT-4 codes for all reviewed visits. Effectively communicates with and acts as a resource to health care providers, department managers and staff to resolve documentation, charge or other issues as they arise to ensure accuracy of coding and reimbursement. HIM Documentation Auditor will be the final source of code determinations when questions arise from new and established coders and will help oversee the coding education and training and ongoing skills assessment process within the coding ranks. The HIM Documentation Auditor will assist with the review and audit of records for the Medicare Recovery Audit Contractor (RAC), Medicare ZPIC (Zone Program Integrity Contractor), Medicaid Integrity Contractor (MIC), Medicare CERT (Comprehensive Error Rate Testing Program), Medicaid DRG Education program, and other government entity audit activities, ensures interdepartmental collaboration in the audit process, and proactively educates healthcare providers, coders, and other team members within the system to promote compliance with government issues and proper billing regulations related to coding. Works closely with the Revenue Integrity Team and the Medical Director of Case Management to respond to regulatory denials for the purpose of compliance and financial integrity. The HIM Documentation Auditor acts as liaison and provides coding education and guidance to the Clinical Documentation Improvement Specialists who perform concurrent record review and initial APR-DRG and MS-DRG assignments. The HIM Documentation Auditor has a significant role in identifying appropriate revenue opportunities for the organization both on front end monitoring of coding and back end audit reviews both internally and per regulatory denials.


Minimum: High school diploma required Associates or Bachelor's degree in Health Information Management or related field including a clinical nursing background is preferred. Preferred: Registered Record Administrator, Accredited Record Technician, or Certified Coding Specialist or Certified Professional Coder.


Minimum of 10 years of facility coding experience utilizing, ICD-9-CM, CPT-4, HCPCS Level II and experience in all phases of acute care facility coding and abstracting (inpatient, emergency room, ambulatory surgery, and ancillary). Coding experience must include in-depth knowledge of ICD-9-CM, CPT-4, HCPCS, DRG's, APR-DRG's, APC's, and POA determination.

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