Audit Specialist conducting risk based audits at RTX Corporation. Engaging in process improvements and presenting insights to senior management while facilitating project management and coaching staff.
About the role
- Auditing inpatient medical records with a focus on coding accuracy and compliance. Responsible for mentoring coders with ongoing feedback and training.
Responsibilities
- Conduct detailed DRG validation audits on selected inpatient medical records to ensure coding accuracy, completeness, and compliance with ICD-10-CM/PCS, AHA Coding Clinic, and CMS guidelines.
- Review documentation to confirm that all reported diagnoses and procedures are supported and coded to the highest level of specificity.
- Validate the assignment of the discharge disposition, Present on Admission (POA) indicators, and sequencing of diagnoses.
- Identify and correct discrepancies between coded data and clinical documentation.
- Ensure adherence to all official coding guidelines, facility policies, and payer-specific rules.
- Monitor and analyze audit trends to identify coding or documentation issues impacting data quality and reimbursement.
- Collaborate with the Compliance Department to address audit findings and ensure regulatory adherence.
- Provide ongoing feedback and coaching to coders and Clinical Documentation Improvement (CDI) Specialists to enhance coding accuracy and documentation quality.
- Develop and deliver targeted training sessions on DRG optimization, clinical indicators, coding guidelines, and audit findings.
- Maintain detailed and accurate records of all audit activities and findings.
- Prepare periodic audit reports summarizing trends, root causes, and recommendations for improvement.
- Work closely with CDI teams, physicians, and other clinical staff to clarify documentation and ensure accurate code assignment.
Requirements
- Bachelors in nursing preferable / Bachelor's in science.
- Certification- Mandatory CCS - Certified Coding Specialist, CIC - Certified Inpatient Coder
- Auditing experience on IP DRG.
- Knowledge in Microsoft outlook/excel/word.
- Exposure on 3M software and NLP tool.
Benefits
- Good excel skills
- Flexibility
- Good Communication
Job title
Job type
Experience level
Salary
Not specified
Degree requirement
Location requirements
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