Clinical Coding Audit Specialist, HIM, Full Time, Days
Miami, Florida
The Clinical Coding Audit Specialist, HIM ensures the accuracy, integrity, and regulatory compliance of Diagnosis Related Group (DRG) assignments across the organization.
- Eligibility
- Health Information Management
- Shift and hours
- Days Full Time, Days40 hours a week
- Unit and setting
- Hospital
- License
- RN license Valid Florida RN license is preferred.Valid Florida RN license
- Term
- Permanent Full Time, DaysFull time
Do you qualify?
- Certification
- AHIMA, AAPC or ACDIS certification (e.g., RHIA, RHIT, CCS, CDIP, CDEI, CPC, CIC, COC, CCDS) Certification from AHIMA (e.g., RHIA, RHIT, CCS, CDIP, or CDEI), or AAPC (e.g., CPC, CIC, or COC), or ACDIS (e.g., CCDS) is required.
- Education
- Associate's degree in related field Associate's degree in related field is required.
- Experience
- 5 to 7 years of related experience Generally requires 5 to 7 years of related experience.
- Also asks
- Ability to analyze, organize and prioritize work accurately while meeting multiple deadlines Ability to analyze, organize and prioritize work accurately while meeting multiple deadlines.
- Also asks
- Ability to communicate effectively in oral and written form Ability to communicate effectively in both oral and written form.
- Also asks
- Ability to handle difficult and stressful situations with critical thinking and professional composure Ability to handle difficult and stressful situations with critical thinking and professional composure.
- Also asks
- Ability to understand and follow instructions and exercise sound, independent judgment
- Also asks
- Knowledge and skill in job-appropriate technology and software applications Knowledge and skill in use of job appropriate technology and software applications.
Preferred
- License
- Valid Florida RN license Valid Florida RN license is preferred. Check your license
- Also asks
- Foreign Physician Foreign Physician is preferred.
The role and schedule
- Day to day
- Review DRG downgrades and payer denials to validate documentation and final coding Perform comprehensive reviews of DRG downgrades and payer denials to validate the accuracy of clinical documentation and final coding.
- Day to day
- Validate DRG assignments against ICD-10-CM/PCS, CMS guidelines, UHDDS and organizational policy Validate DRG assignments in accordance with ICD 10 CM/PCS, CMS guidelines, UHDDS definitions, and organizational policies.
- Day to day
- Prepare detailed findings and recommendations to support appeals Prepare detailed findings and recommendations to support appeals when appropriate.
- Day to day
- Track appeals through all levels and ensure Medicare, OCE/MCE and LCD/NCD compliance Track appeals through all levels (first level, second level, external review) and ensure compliance with Medicare regulations, OCE/MCE edits, and LCD/NCD requirements.
- Day to day
- Provide coding expertise and documentation clarification for appeal letters and reconsideration requests Provide coding expertise and documentation clarification to support appeal letters and reconsideration requests.
- Day to day
- Conduct routine and targeted internal audits of inpatient coding and DRG assignments Conduct routine and targeted internal audits of inpatient coding and DRG assignments to ensure compliance with regulatory and payer requirements.
- Day to day
- Identify patterns of coding errors, documentation gaps, or compliance risks and escalate Identify patterns of coding errors, documentation gaps, or compliance risks and escalate findings as needed.
- Day to day
- Maintain audit logs tracking outcomes, trends, and improvement opportunities Maintain audit logs, tracking outcomes, trends, and opportunities for improvement.
- Day to day
- Participate in root cause analysis to reduce future denials Participate in root cause analysis to reduce future denials and strengthen compliance.
- Day to day
- Collaborate with CDI and coding teams on DRG-related denials and prevention strategies Collaborate with CDI and coding teams to analyze DRG related denials and develop prevention strategies.
- Day to day
- Provide feedback, education and clarification to Coding and CDI teams on DRG issues Partner with Coding and CDI teams to provide feedback, education, and clarification on DRG related issues.
- Day to day
- Assist in developing training materials, job aids and best practice guidelines Assist in developing training materials, job aids, and best practice guidelines.
- Day to day
- Communicate audit results and compliance updates to leadership and operational teams Communicate audit results and compliance updates to leadership and operational teams.
- Day to day
- Analyze complex data and prepare reports for executive leadership Analyze complex data, identify trends, and prepare reports for executive leadership.
- Day to day
- Maintain working knowledge of departmental technology, recommend enhancements, ensure system performance Maintain strong working knowledge of departmental technology solutions, recommend enhancements, and ensure optimal system performance.
- Day to day
- Apply independent judgment in evaluating audit findings, appeal opportunities and compliance risks Apply independent judgment in evaluating audit findings, appeal opportunities, and compliance risks.
- Details
- Remote, Florida residents only REMOTE (FL Residents Only)
The workplace
Pay bands, ratios, residency, and unit culture are not in the validated set yet, so what you can plan around today is the place and the market around it. Florida does not take state income tax from your check, and…
Worth asking
- Can you walk me through base pay range and differentials?
- What should I expect for weekend, holiday, call, and rotation?
More questions to askFewer questions
- What orientation, preceptor time, and ongoing unit support are included?
- How are patient load, floating, and staffing support handled day to day?
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Your fit
Original listing
Posted on Jackson Health System’s careers page.
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Miami, FL Full-Time Health Information Management Clinical Coding Audit Specialist, HIM REMOTE (FL Residents Only) Full Time, Days Summary The Clinical Coding Audit Specialist, HIM ensures the accuracy, integrity, and regulatory compliance of Diagnosis Related Group (DRG) assignments across the organization. This role oversees the review, analysis, and appeal of DRG downgrades and payer denials, working closely with Clinical Documentation Improvement (CDI), coding, billing, and clinical teams to promote appropriate reimbursement and maintain compliance with regulatory requirements. Responsibilities Perform comprehensive reviews of DRG downgrades and payer denials to validate the accuracy of clinical documentation and final coding.
Validate DRG assignments in accordance with ICD 10 CM/PCS, CMS guidelines, UHDDS definitions, and organizational policies. Prepare detailed findings and recommendations to support appeals when appropriate. Track appeals through all levels (first level, second level, external review) and ensure compliance with Medicare regulations, OCE/MCE edits, and LCD/NCD requirements.
Provide coding expertise and documentation clarification to support appeal letters and reconsideration requests. Conduct routine and targeted internal audits of inpatient coding and DRG assignments to ensure compliance with regulatory and payer requirements. Identify patterns of coding errors, documentation gaps, or compliance risks and escalate findings as needed.
Maintain audit logs, tracking outcomes, trends, and opportunities for improvement. Participate in root cause analysis to reduce future denials and strengthen compliance. Collaborate with CDI and coding teams to analyze DRG related denials and develop prevention strategies.
Partner with Coding and CDI teams to provide feedback, education, and clarification on DRG related issues. Assist in developing training materials, job aids, and best practice guidelines. Communicate audit results and compliance updates to leadership and operational teams.
Analyze complex data, identify trends, and prepare reports for executive leadership. Maintain strong working knowledge of departmental technology solutions, recommend enhancements, and ensure optimal system performance. Apply independent judgment in evaluating audit findings, appeal opportunities, and compliance risks.
Performs all other related job duties as assigned. Experience Generally requires 5 to 7 years of related experience. Education Associate's degree in related field is required.
Foreign Physician is preferred. Skill Ability to analyze, organize and prioritize work accurately while meeting multiple deadlines. Ability to communicate effectively in both oral and written form.
Ability to handle difficult and stressful situations with critical thinking and professional composure. Ability to understand and follow instructions. Ability to exercise sound and independent judgment.
Knowledge and skill in use of job appropriate technology and software applications. Credentials Certification from AHIMA (e.g., RHIA, RHIT, CCS, CDIP, or CDEI), or AAPC (e.g., CPC, CIC, or COC), or ACDIS (e.g., CCDS) is required. Valid Florida RN license is preferred.
Jackson Health System is an equal opportunity employer and makes employment decisions without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, disability status, age, or any other status protected by law
What's around it?
Miami, FLFrom Census ACS 2024.
Living costs about 14% above the US average
- Median rent
- $1,758/mo
- Household income
- $62,462/yr, all local households, not nurse pay