Manager, Hospital Audit Services - Ardent Health Services

Ardent Health Services (AHS) is a national health care services company headquartered in Nashville, TN. Through its subsidiaries, Ardent owns and operates nearly 200 sites of care. Our subsidiaries own and operate hospitals and multispecialty physician practices in six states. Ardent includes 30 hospitals, 4,423 patient beds, 23,000 employees, and 1,700 employed physicians. Within the industry, we are noted for recognizing that every hospital is as unique as the community it serves. This in-depth understanding of how health care works at the local level is one of our great strengths.

POSITION SUMMARY

The Manager, Hospital Audit Services will possess the technical abilities to manage the day-to-day audit operations. The Manager, Hospital Audit Services will ensure accurate and compliant application of correct audit principles for hospital fee workflows, documentation, and coding.

• Manages, coordinates, and oversees daily activities, personnel, and operations of the department.
• Acts as interdepartmental liaison to resolve documentation and audit questions.
• Monitors auditor accuracy to ensure guidelines are being followed.
• Monitors the timeliness of audits.
• Assist with internal coding audits. Prepares and maintains statistical reports and record as needed.
• Liaison with revenue cycle management for proper coding.
• Cooperates and interacts with Vice President, directors, managers, supervisors, peers, other departments.
• Conducts reviews and provides expert guidance on highly complex accounts (both from a DRG, CC, MCC, SOI and ROM perspective).
• Training and educating coders/auditors and clinical staff one on one or in group settings.

Education & Experience:

• Associate’s degree in related Health Care field; experience may be considered in lieu of education.
• Coding/HIM certification required (e.g. CCS-P, RHIA, RHIT, CIC, CCDS, CDIP).
• 5+ years of MS DRG/APR DRG coding or auditing experience with expert knowledge of ICD-10CM guidelines and DRG reimbursement methodologies.
• 2+ years prior supervisory experience, preferred.

Knowledge, Skills & Abilities:

• Knowledge of ICD-10-PCS coding methodologies, code sequencing and discharge disposition in accordance with CMS requirements, Official Guidelines for Coding and Reporting, and Coding Clinic guidance
• Strong analytical skills
• Understanding of medical terminology, anatomy and physiology
• Understanding of Medicare Outpatient Prospective Payment System (OPPS), Medicare Inpatient Prospective Payment System (IPPS), Ambulatory Payment Classification (APC) and Rural Health (RHC)
• Understanding of CMS rules and regulations
• Understanding of coding resources and tools
• Ability to handle confrontational situations
• Assumes ownership of assignments, special projects, pilot programs; other duties as assigned or requested.
• Communicates and listens effectively with internal and external customers; effectively understands instructions and shares knowledge.