Team Lead, Inpatient Auditing

Penstock is a service partner and SaaS builder for forward-thinking health plans and providers, empowering recovery, audit, and regulatory teams to get accuracy right from the start—when it matters most. Our mission is to create lasting systemic change that removes wasted spend from our healthcare system, returning dollars to payers, lowering the cost of care, and improving access for all. Our business model is rooted in transparency and the drive to reinstate true integrity in payment integrity—even if it defies traditional business sense. We geek out over building and perfecting software that helps health plans succeed, but we also understand the irreplaceable value of human intelligence.  Penstock is an Equal Opportunity Employer.

Role and Responsibilities

The Team Lead of DRG Inpatient Auditing is responsible for overseeing the quality and delivery of complex prepayment and retrospective inpatient coding and clinical validation audits.  This role ensures accuracy, consistency and compliance with CMS regulations, ICD-10 guidelines, and payer-specific requirements, while supervising and mentoring a team of auditors.  The Team Lead provides second-level review, client deliverables, coding and clinical education, and quality assurance to support both client and company goals.

• Audit the Auditor (ATA to ensure accuracy, consistency, and compliance.  Provides ongoing guidance and feedback to auditing team based on ATA findings 
• Subject Matter Expert (SME) handling high-level complex audits
• Writes complete, clear, and accurate Appeal Reconsiderations (1st Level, 2nd Level, and 3rd Level (Consulting with Medical Director for additional support)
• Training Coach Mentor – Conducts Onboarding and Orientation for new Team Members and Contract Auditors.  Lead education sessions to keep abreast of coding updates and regulatory changes
• Monitors daily assignment queues and new daily audit assignment report to ensure timely completion of assignments and adequate workload coverage
• Monitors and tracks performance metrics to ensure auditor accuracy and ability to meet expectations
• Analyze audit results to identify patterns and potential concept development
• Ensure all audits adhere to ICD-10-CM Official Guidelines for Coding & Reporting, AHA Coding Clinic Guidance, AHIMA/ACDIS Guidelines for Achieving a Compliant Query Practice (2022 Update),AHIMA Standards of Ethical Coding, HIPAA and compliance policies.

Qualifications and Education Requirements:

• Minimum of an associate degree
• Current AHIMA Health Information Management Credential(s): RHIT or RHIA
• Current AHIMA/AAPC Coding or Auditing Credential:  CCS, CIC, CPMA
• Current AHIMA, ACDIS, AAPC Clinical Validation credential(s):  CDIP, CCDS, or CDEI
• 3 or more years of ICD-10 inpatient coding experience
• 1 or more years of clinical experience in a healthcare facility setting
• 3 or more years of DRG auditing experience (or demonstrated equivalent)
• 1 or more years of DRG auditing experience in a payor setting
• Comprehensive understanding of all coding guidelines and DRG grouping mechanics
• Strong current clinical knowledge base
• Familiarity with Clinical Documentation Integrity practices
• Awareness of and adherence to HIPAA, and all laws regarding the safeguarding of PHI/PII
• Ability to conduct independent research using credible sources
• Demonstrated working knowledge of Microsoft Word, Excel, and PowerPoint
• Ability to apply critical thinking skills
• Ability to work independently, manage workload, and adapt to shifting priorities
• Willingness to adapt and learn new auditing skills for coding and clinical scenarios
• Excellent communication skills, both oral and written
• Comfortable working in an ever-changing fast paced environment
• Able to work Eastern time zone hours
• Secure and private home office with reliable high-speed internet connection

 Preferred Skills

• Bachelor’s degree or higher
• 5+ years of inpatient ICD-10 coding and auditing experience
• 5+ years of relevant auditing (clinical validation and medical necessity) experience
• 5+ years of relevant DRG auditing experience (dual coding and clinical audits)
• 1+ years experience in Inpatient Rehab or Inpatient Psychiatric Coding/Auditing

Penstock is an affiliate company of Goodroot, which launches and grows companies dedicated to putting patients back in the center of healthcare.

About Goodroot

Goodroot is a community of companies committed to delivering more access to better healthcare at a lower cost. With a growing group of brands including, but not limited to Penstock, Navion, and Emry, Goodroot is reshaping healthcare for good, one system at a time. Learn more at www.goodrootinc.com.