As a part of the Tenet and Catholic Health Initiatives household, Conifer Health brings 30 years of health care industry competence to customers in more than 135 local areas nationwide. We help our customers strengthen their monetary and clinical efficiency, serve their neighborhoods and be successful at business of healthcare. Conifer Health assists companies shift from volume to value-based care, improve the customer and client health care experience and enhance quality, expense and access to healthcare. Are you all set to be part of our services? Invite to the company that gives you the resources and rewards to redefine health care services, with a competitive advantages plan and management to take your profession to the next action!
TASK SUMMARY
Conducts risk-based coding quality audits, random quality audits, and semi-annual quality audits of inpatient and outpatient encounters to validate code task remains in compliance with the official coding standards as supported by medical paperwork in health record. Validates abstracted data aspects that are important to appropriate payment methodology.
IMPORTANT RESPONSIBILITIES AND DUTIES
Consist of the following. Others may be assigned.
Understands, analyzes and applies coding standards for coding audits. Audits inpatient and outpatient encounters code projects. Review of medical records to figure out coding precision of all documented medical diagnoses and procedures. Evaluations claims to verify submitted codes and abstracted information consisting of but not restricted to ICD-9/10 CM/PCS codes, MS-DRGs, CPTï ¿ 1/2 s, APCï ¿ 1/2 s, and discharge personality which all effect facility compensation.
Produces clear and precise audit findings and recommendations in written audit reports that will be used for advising and educating Coders, Auditors, Managers, and Directors throughout the company.
Determines documents concerns (doing not have documents, missed physician questions, etc.) that effect coding precision. Plainly interacts (verbally and in written reports or summaries) opportunities for paperwork enhancement related to coding issues.
Stays present with AHA Official Coding and Reporting Guidelines, CMS and other company instructions for ICD-9/10- CM/PCS and CPT coding. Completes online education courses and attends obligatory coding workshops and/or seminars (IPPS and OPPS, ICD-9-CM and CPT updates) for inpatient and outpatient coding. Evaluations AHA and CPT quarterly coding upgrade publications. Goes to all internal teleconference for Quarterly Coding Updates.
FINANCIAL OBLIGATION (Specify Revenue/Budget/Expense):
- Supplies input concerning departmental spending plan particular to location of obligation.
Qualifications:
UNDERSTANDING, ABILITIES, CAPABILITIES
To perform this job successfully, a specific need to have the ability to carry out each important task adequately. The requirements noted below are representative of the understanding, ability and/or ability needed. Sensible lodgings may be made to allow people with specials needs to carry out the essential functions.
- Ability to consistently and properly audit coding of inpatient and outpatient encounters
- Ability to create clear and succinct audit reports and preserve efficiency requirements
- Should successfully pass pre-hire coding evaluation
- Understanding of medical terms, ICD-9/10 CM/PCS, EM, and CPT-4 coding standards and approaches
- Understanding of illness pathophysiology and drug utilization
- Knowledge of MS-DRG classification and repayment structures
- Understanding of APC, OCE, NCCI category and reimbursement structures
- Need to be detail oriented and have the ability to work independently
- Computer knowledge of MS Office
- Need to show exceptional social skills
- Ability to demonstrate effort and discipline in time management and task conclusion
- Capability to operate in a virtual setting under minimal guidance
EDUCATION/ EXPERIENCE
Include minimum education, technical training, and/or experience chosen to carry out the job.
- Associates degree in relevant field preferred or combination of equivalent of education and experience
- 3 (3) years coding experience consisting of however not limited to medical facility inpatient and outpatient encounters
- One (1) year of experience in coding audit or quality review work consisting of however not restricted to medical facility inpatient and outpatient encounters.
REQUIRED CERTIFICATIONS/LICENSURE
Include minimum certification needed to carry out the job.
AHIMA and/or AAPC Coding Credential, CCS preferred
PHYSICAL NEEDS
The physical demands explained here are representative of those that must be fulfilled by a worker to effectively carry out the vital functions of this job. Reasonable accommodations might be made to make it possible for individuals with specials needs to perform the necessary functions.
- Must have the ability to work in sitting position for prolonged durations
Task: Conifer Health Solutions
Primary Location: Frisco, Texas
Job Type: Full-time
Shift Type: Days
Work practices will not be affected or affected by an applicantâ s or employeeâ s race, color, religious beliefs, sex (consisting of pregnancy), nationwide origin, age, disability, hereditary info, sexual orientation, gender identity or expression, veteran status or any other lawfully secured status. Tenet will make reasonable accommodations for qualified people with disabilities unless doing so would result in an unnecessary hardship.
NACCHO.
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