RN Auditor/Coder

Hello. I'm not quite sure if this is the correct place for this but here it is...

I'm interested in a position as a Nurse Auditor. Some of these positions require coding certification and some require "familiarity" with CMS guidelines and ICD-9 codes.

What at is the best way to "familiarize" yourself with CMS guidelines and coding? Is it really worth it to become a certified coder? I'm not sure exactly what type of experience these companies are looking for when it comes to this. I've worked in an acute care setting for 7 years and have worked closely with case management and am aware of what differentiates an inpatient vs. observation stay and what qualifies a patient for either. I'm aware of the 2 midnight rule and other basic CMS stuff. Is this enough?

Long post short:

1) Should I obtain coding certification for this type of position even if it's not required? Is it that useful and does it make me that much more valuable as a potential employee?

2) How do I familiarize myself with CMS guidelines?

Thank you!

13 Answers

You will likely need a coding certification to be considered for an auditing position. You can 'easily' learn the rules and regulations, however recruiters will consider the ones with coding credentials, first. I actually experienced this, firsthand; I had applied and put my resume up on job boards with not one offer after several months. As soon as I got my CCS (through AHIMA), I received numerous offers for coding, auditing and CDI within a couple weeks.

Auditing is not for everyone, but I truly enjoy it; If it's a remote position, working from home, or anywhere there is internet connection is a huge plus.

As for job outlook, I think there will be a HUGE demand for nurse coders/auditors, especially with ICD-10 implementation. You'd be surprised how much fraud and abuse is going on throughout the nation.

In order to qualify to take the CCS examination, you need to take an actual class for it; these usually take a year or so.

AFAIK, there is no course on the AHIMA website that will qualify you for the CCS.

Certified Coding Specialist (CCS)

Just go to the link above to read more on the CCS.

Ask away, if you have any questions.

-Richard

Specializes in Quality Improvement / Informatics.

We are not yet concurrent, but we have taken months of core measure (CM) retroactive abstraction down to about being only 2 or so weeks behind. This has become easier in the last 6 months as many of the CMs have been removed, per CMS. We just have to wait for our online vendor to drop in the cases to the web tool so we can begin abstraction.

Unfortunately, our EHR is not quite robust enough yet for us to complete realtime abstraction. We do have CMRNS who concurrently review charts on the floor to do do realtime education and have clinicians complete documentation and ordering to meet the measures.

We're getting there - I hope this is helpful ?

Specializes in Quality Improvement / Informatics.
Can you explain what is abstract Core Measures

Yes - it is auditing patient charts while they are either still in the hospital or have gone home.

The purpose is to gather data mainly for The Joint Commission or The Center for Medicare and Medicaid Services (CMS). They want to see that hospitals are providing the "right" care to patients based on a particular disease or medical problem, such as those with heart attacks, those who smoke or those that come in for a surgery - in order to improve their outcomes. They have measure sets, such as "AMI - Heart Attack" and the indicators are the specific actions the clinician needs to complete, such as "Did the patient receive an aspirin within 24 hours of arrival to the hospital". If they did, they pass the measure, if not, it is considered a failure/variance and the hospital gets dinged by either TJC or CMS for it.

Collecting core measures (both inpatient and outpatient) are required federal programs, and with CMS, some indicators have financial impact for the hospital on how well they do on core measures. Also, the hospital data collected is publicly reported, so patients can look at how well a hospital is doing on core measures, to make an informed decision if they want to seek care at that hospital. Clinical core measures are one of the indicators of quality care in a facility.

Core measure abstraction is interesting and very detailed work. It is a great way to support quality care in a healthcare organization.

Specializes in Neonatal-Pedi, Hospice, Triage, Abstraction.

After reading about data abstraction and applying for a few positions I discovered on another thread that these jobs will slowly disappear due to real time extractions being coded into software(?). It's really helpful when those on the "inside" can provide insight and guidance. I having been doing a lot a research trying to decide how to best transition into a REMOTE/ WFH- work from home- position. It appears that 20years of nursing with diverse clinical background (NICU, Ped's, Home Health/Hospice, case management, QUAPI, and admin experience is not enough to crack the door open. So time to pursue some certifications in Coding and Auditing. I'm trying to decide between the 2 organizations: AHIMA: CCA- Certified Coding Associate and then follow with CDIP- Clinical Doc Improvement Practitioner. Or AAPC: CPC- Cert Professional Coder and CDEO Cert Documentation Expert. When I search these keywords on Indeed the credentials seem in demand, just hope the extra time effort and money translates into a landing a good job! Any insider direction, insights or pointers WELCOMED!!

Specializes in Neonatal-Pedi, Hospice, Triage, Abstraction.

I know this is a very late reply but I did land an ICD coding position without earning my CPC. This company preferred nurses over non clinical coders (CPC' CCS). They provided in-house training that was very organized and structured. But equally designed to progressivly squeeze out nurses that did not meet thier high production quotas & standards. Im glad I did not invest in getting my CPC license because I learned even though I could do it, I REALLY REALLY disliked it. Most recently I took a on line HEDIS training course and combined with my QA/Admin experience landed a position for the 2019 season. Down side is it is non salary IC and pays strickly per chart/review. Think Ill do better and be more productive on good old self motivation vs pressure of high quotas. Id love to hear an update on what yor doing, we all have to find our niche. WFH is hard work, all those physical skills get flipped into added mental strain. I dont miss comutting in traffic and enjoy the perks of my dog laying at my feet while sipping my coffee in PJ's. Hope your doing the same

Specializes in Peritoneal Dialysis, QA.

Were you not required to code for 1 year prior to auditor testing ? What school did you use? Thanks

Hi everyone

I want to start a training program for coder/auditor. After reading the few post on this site I am still confused as to how to start.

I have find different organizations that have different programs. So I'm not sure what course I would need to take. Can anyone recommend a specific program?

I also read that to become a auditor you need experience in coding first how true is this? Are these company out there that would hire without experience?

It seem like the people that are in this field fell into it and didn't necessary choose it.

Specializes in Quality Improvement / Informatics.

I'm interested in a position as a Nurse Auditor. Some of these positions require coding certification and some require "familiarity" with CMS guidelines and ICD-9 codes...

What at is the best way to "familiarize" yourself with CMS guidelines and coding?

2) how do I familiarize myself with CMS guidelines?

If you are happen to be interested in data abstraction/auditing for clinical Core Measures (not sure if that is what you mean as well) I can help you find those CMS guidelines!

Rg

Thank for a the response. I looked at the AHIMA website that direct me to the cancer registry website for the training. Under basic coding there are over 12 different course.

Did you take all there courses or only a few.

If you are happen to be interested in data abstraction/auditing for clinical Core Measures (not sure if that is what you mean as well) I can help you find those CMS guidelines!

Just wanted to say Hello QualityInfoRN. I abstract Core Measures too. Do you abstract concurrently or post stay? Just wondering, I have been in this position for 1 and 1/2 years and I will be trying concurrent for the first time this week.

Just wanted to say Hello QualityInfoRN. I abstract Core Measures too. Do you abstract concurrently or post stay? Just wondering, I have been in this position for 1 and 1/2 years and I will be trying concurrent for the first time this week.

Can you explain what is abstract Core Measures

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