Coding Auditor

Job Description

ECU Health

About ECU Health

ECU Health is a mission-driven, 1,708-bed academic health care system serving more than 1.4 million people in 29 eastern North Carolina counties. The not-for-profit system is comprised of 13,000 team members, nine hospitals and a physician group that encompasses over 1,100 academic and community providers practicing in over 180 primary and specialty clinics located in more than 130 locations.

The flagship ECU Health Medical Center, a Level I Trauma Center, and ECU Health Maynard Children’s Hospital serve as the primary teaching hospitals for the Brody School of Medicine at East Carolina University. ECU Health and the Brody School of Medicine share a combined academic mission to improve the health and well-being of eastern North Carolina through patient care, education and research.

Position Summary

Auditing of inpatient/outpatient records for quality of coding. These would include charts that have been flagged by the 3M Audit Expert Tool as well as other audits deemed necessary by VMC and/ or the Coding Manager. Contact person for the Clinical Documentation Specialists. Assist the coding supervisor with the education, training, and auditing of new coders charts. Additionally, serve as back up for coding, billing, and abstracting of outpatient, ED, and ambulatory surgery same day surgery records. All activities must be accomplished in accordance with national and facility approved coding guidelines and rules and prospective payment methodologies.

Activities must also be performed with adherence to Federal Compliance Regulations and Medical Necessity Guidelines. Average coding accuracy must be consistently maintained at 95% or better.

Contacts physicians, residents, and other health care professionals to clarify difficult medical record documentation to insure accurate code assignment. Contacts and assists physicians, residents, and other health care professionals with completion of medical records, as required by JCAHO. Completes statistical forms and tracking logs.

Performs additional duties as requested by manager.

Responsibilities

Audit inpatient/outpatient records. This might be done on charts flagged by the 3M Audit Expert system or charts being reviewed for a specific study. The auditor is expected to meet with the original coder if she finds there is a coding difference. The auditor would explain why she came up with a different code and educate the coder to various Coding Clinics or educational material that she might have overlooked in determining her original code. Additionally, serve as back up for

Coding, billing, and abstracting of outpatient, ED, and ambulatory surgery/same day surgery records. All activities must be accomplished in accordance with national and facility approved coding guidelines and rules and prospective payment methodologies. Activities must also be performed with adherence to Federal Compliance Regulations and Medical Necessity Guidelines.

Contact person for the Clinical Documentation Specialists. The auditor is available to all the Clinical Documentation Specialists to assist them in deciding on the correct DRG assessments for problem or questionable accounts. The auditor also helps in the education of the Specialists as to the proper or necessary query that needs to be asked of a physician in order to clarify the information that had been recorded in the patients current record.

Coding accuracy must be consistently maintained at 95% or better. All charts should be reviewed in a timely manner so accounts can be billed. All coding changes made should be reviewed with the original coder for educational purposes. If there is a difference of opinion between the auditor and the coder, the auditor will bring the account to the attention of the coding supervisor who will determine the proper coding for the account.

Reviews the entire medical record in the HIMS Imaging System to determine Principal Diagnosis, complications & comorbidities, secondary diagnoses, Principal Procedure, and secondary procedures. Also reviews for E-codes for Trauma Registry, Morphology codes for Cancer Registry, consultations for hospital database, and Adverse Drug Reactions for Pharmacy & JCAHO requirements.

Assigns codes for each of the above utilizing the 3M Encoder. Inpatient records require ICD-9-CM code assignments. Outpatient, ED, and Ambulatory Surgery records that have Medicare or Champus as their primary insurance require ICD- 10-CM diagnosis codes and CPT procedure codes. All coding decisions must be accomplished in accordance with national and facility approved coding guidelines and rules and prospective payment methodologies - at times, this may require the coder to research many reference manuals or query physicians for information to insure accurate code assignments. Additionally, coding decisions must adhere to Federal Compliance Regulations and Medical Necessity Guidelines.

Sequences codes appropriately for optimal reimbursement and transmits codes from 3M Encoder to the Epic computer system for billing..


Contacts physicians, residents, and other health care professionals to clarify difficult medical record documentation to insure accurate code assignment.

Contacts are made by phone or MD Query Form. Information is documented on the MD Query Form for future reference and to substantiate any appeals that may be necessary for reimbursement.


Contacts and assists physicians, residents, and other health care professionals with completion of medical records, as required by JCAHO.

Contacts physicians and/or residents to complete dictation of discharge summaries, discharge order sheets, and operative reports, as necessary, for accurate code assignments, and to comply with JCAHO standards.

Auditor is responsible for completing a daily productivity form indicating the number of records audited for the day and the category of each audit, the number of Clinical Specialists conversations, and the number of hours worked.
Additionally, the auditor is responsible for completing a weekly productivity report that reflects all activities accomplished for that week.


Performs additional duties as requested by manager including attendance at any meetings dealing with auditing issues, compliance, etc. that the auditor could bring back to the attention of the coding staff.

Auditor may be requested to do internet research for further clarification of new procedures, diseases, or medications. She then might be requested to do an education session for the coding staff.

Attends and participates in educational programs or inservices to keep abreast of changes and/or developments in coding rules/regulations, Medical Necessity, and Federal Compliance Regulations.

Maintains updated ICD-10-CM and/or CPT coding reference materials.

Identifies records that may be converted to another billing status (inpatient to outpatient) and informs appropriate individuals.


Performs work with a team player attitude; is loyal to the department goals and objectives; and is supportive of management and colleagues.

Minimum Requirements

High School plus 2 years or more of formal training or education. College Degree: Health Information Technology

Formal Courses in ICDCM/PCS coding, CPT coding, medical terminology, anatomy & physiology, pathophysiology (disease processes). Individual will be required to produce transcripts of successful completion (C or higher).

A RHIA, RHIT, or CCS is a requirement for this position.

5 years or more experience coding experience in a medically relevant setting is required.

General Statement

It is the goal of ECU Health and its entities to employ the most qualified individual who best matches the requirements for the vacant position.

Offers of employment are subject to successful completion of all pre-employment screenings, which may include an occupational health screening, criminal record check, education, reference, and licensure verification.

We value diversity and are proud to be an equal opportunity employer. Decisions of employment are made based on business needs, job requirements and applicant’s qualifications without regard to race, color, religion, gender, national origin, disability status, protected veteran status, genetic information and testing, family and medical leave, sexual orientation, gender identity or expression or any other status protected by law. We prohibit retaliation against individuals who bring forth any complaint, orally or in writing, to the employer, or against any individuals who assist or participate in the investigation of any complaint.

Contact Information

For additional information, please contact:

Angie Nichols, Talent Acquisition Consultant

ECU Health Talent Acquisition

Email: [email protected]