Full-Time Coding Auditor & Quality Coordinator

Coding Quality Auditor and Specialist reflects the mission, vision, and values of NM, adheres to the organization’s Code of Ethics and Corporate Compliance Program, and complies with all relevant policies, procedures, guidelines and all other regulatory and accreditation standards.

Expert in clinical documentation and coding. Works in tandem with the Clinical Documentation Team to assure quality metrics are held to the highest standard.

Assures coding guidelines and regulations are not compromised during the decision-making process related to clinical documentation and coding.

Partners with Clinical Documentation Nurses, Physicians, and other licensed providers to improve the quality of documentation, assuring best quality performance and representation of care provided.

Collaborates with CMOs to ensure the integrity of the Health Record through best practices in Clinical Documentation and Coding.

Maintains quality work queues and quality reports, and performs advanced and complex project work including, but not limited to, Risk Adjustment, Mortality Review, Hospital Acquired Condition (HAC) and Patient Safety Indicator (PSI) Review, Quality Abstraction and Analysis, and/or special and non-traditional project work.

Mastery of advanced clinical documentation integrity and quality concepts, coupled with the ability to consistently identify root causes and deliver measurable results.

Leads and facilitates quality initiatives and external rankings initiatives while remaining compliant with coding guidelines and regulations.

Solves complex problems and adds new perspectives to existing solutions. Applies advanced knowledge of the national quality agenda and clinical documentation integrity and coding compliance to advance problem analysis and creative process redesign.

1. Collaborates with clinical documentation team in the review of inpatient accounts (with an emphasis on mortality reviews) identifying documentation improvement opportunities.
2. Assesses DRG, PDx, secondary Dx, PCS, POA and all other components of documentation that impact quality metrics.
3. Assures coding practices remain compliant with coding guidelines and regulations.
4. Continuously identifies educational opportunities related to coding and documentation.
5. Expert educator to clinical teams and medical staff.
6. Identifies strategic plans that will result in a positive impact to the clinical dashboard.
7. Develops clinical relationships across the health system securing interdepartmental support necessary for successful implementation of education strategies assuring achievement of overall strategic targets.
8. Ability to multi-task a variety of audits
9. Analyzes data and constructs appropriate action plans.
10. Develops teaching tools to promote quality outcomes.
11. Is an active member of clinical and executive meetings.
12. Advanced understanding of quality metrics for health system (Vizient, PSI, USNWR).
13. Advanced understanding of clinical documentation and coding through the lens of local and national quality and ranking methodologies, including but not limited to, U.S News and World Report, Vizient, Leapfrog, the CMS Star Rating, and payer contracts and assists the Managers of ClinicalDocumentation and Coding in implementing key strategies to effect change.
14. Partners with Coding, Clinical Documentation leadership and Medical Directors to coordinate, maintain, and execute advanced project work that includes but, is not limited to, Mortality Review, HAC/PSI Review, Quality Abstraction and Analysis, and/or special and non-traditional project work.
15. Partners with NM departments (including but not limited to: IT; Analytics; and Innovation) to design and implement new and advanced workflow solutions.
16. Partners with third-party consultants/partners to contribute to workflow and methodology build and refine as necessary.

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