Position Purpose
This position is accountable for the coordination of quality audits for coding personnel. In addition, this position is accountable for auditing as part of the Coding Reimbursement Team and the reporting of audit results to Leadership. The focus of this position is to collaborate all elements of audit entities, consisting of outdoors ask for compliance and billing, consisting of and not restricted to RAC and/or other auditing programs investigate demands.
This position is accountable to preserve department policies stated by Leadership and keeping up with continuous modifications in coding and billing standards and compliance associated to compensation within federal and State guidelines. This incumbent is to have skilled understanding of precisely designating ICD-9-CM/ ICD-10- CM diagnostic and treatment codes for all elements of center coding. This list is to consist of Acute Inpatient, Level II Trauma, Rehab Facility, Skilled Nursing, Home Health in addition to Hospice. ICD-9-CM/ ICD-10- CM/PCS and CPT code projects should follow CMS Official Guidelines, regulative companies and health center particular laws and standards.
Nature and Scope
The significant difficulty of this position is to collaborate the coding personnel auditing schedules for quality and efficiency to guarantee compliance of Coding/Auditing, Coding and documents quality, which precise repayment is being met quality coding requirements. This position is responsible for auditing details coded from service provider documents and client medical records within the designated amount of time in order to accelerate the billing procedure make sure precise compensation for services rendered and to promote compliance.
All findings acquired in the auditing arena need to be recorded and reported to Coding and Financial Leadership.
This position has access to exclusive info and has contact with external companies, which mandates high requirements of professionalism, interaction, efficiency, and regard for privacy. This position is challenged to be familiar with the continuous modifications in Federal and State policies.
This position is liable to preserve department policies and bring problems and the requirement for revised/additional policies and treatments to management’s attention.
This individual should have the ability to recognize and solve issues, set objectives and top priorities, and represent the department in an expert way along with in the lack of Leadership, as designated.
High requirements of efficiency, courteousness, diplomacy, and regard for privacy are necessary.
Job obligations can consist of task of diagnostic codes by skilled analysis and translation of diagnostic declarations, doctor orders, and other essential paperwork resulting in coding precision and abstracting of essential information components from documents supplied.
The foregoing description is not planned and ought to not be interpreted to be an extensive list of all duties, abilities and efforts or work conditions connected with the task. It is meant to be a precise reflection of the basic nature and level of the task.
Incumbent need to have capability to:
- Address appeals and evaluation required info for insurance coverage rejections to assist in profitable resolution and repayment.
- Participates in mandated Medical Record Review procedures.
- Interprets and uses American Hospital Association (AHA) Official Coding Guidelines to articulate and support suitable principal, secondary medical diagnoses and treatments.
- Insures that all aspects required for appointing precise DRG exist, which associated medical diagnoses are ranked correctly.
- Assign precise present on admission signs.
- Provides info and reacts to questions relating to medical documents and DRG’s to CDI personnel consisting of Utilization and Quality Assurance Departments when required.
- Knowledge of discharge personality and repayment results.
Other duties consist of:
- Adherence to Health Information Management (HIM) Coding policies.
- Adherence to The Joint Commission (TJC) and other 3rd party documents standards in an effort to constantly enhance coding quality and precision.
- Responsibility for keeping coding accreditation and referencing present ICD-9/ ICD-10 coding standards and regulative modifications.
- Participates in efficiency enhancement efforts as appointed.
The incumbent should regularly satisfy or surpass efficiency and quality requirements as specified by the HIM Coding Leadership.
Telecommuting is permitted with approval from HIM Management.
KNOWLEDGE, SKILLS & ABILITIES
1. Specialist understanding and particular information of coding conventions and usage of coding classification constant with CMS’ Official Guidelines for Coding and Reporting ICD-9-CM/ ICD-10- CM coding.
2. Incumbent need to have comprehensive understanding of Anatomy and Physiology of the body, Disease Pathology, and Medical Terminology in order to comprehend the etiology, pathology, signs, indications, diagnostic research studies, treatment methods, and diagnosis of illness and treatments carried out.
3. Precise translation of composed diagnostic descriptions to properly and precisely appoint ICD-9-CM/ ICD-10- CM diagnostic codes and procedural codes to acquire ideal repayment from all payer types, consisting of Medicare/Medicaid, and personal insurance coverage payers.
4. Capability to fix Epic Coder lines and Optum workflows to report concerns to HIM Coding Leadership.
5. Understanding of medical material requirements.
6. Capability and understanding of the appeal procedure to make sure precise compensation.
This position does not supply client care.
Disclaimer
The foregoing description is not meant and must not be interpreted to be an extensive list of all obligations, abilities and efforts or work conditions related to the task. It is planned to be a precise reflection of the basic nature and level of the task.
Minimum Qualifications
Requirements – Required and/or Preferred
Name
Description
Education:
Must have working-level understanding of the English language, consisting of reading, composing and speaking English. Bachelors Degree in Health Information Management is chosen.
Experience:
A minimum of 4 or more years of gradually accountable and sophisticated experience in health care coding. Experience in all client types along with experience and understanding of required compliance requirements for all center types is needed.
License( s):
None
Certification( s):
CCS or RHIA/RHIT with a minimum of 4 years of center coding experience is needed.
Computer/ Typing:
Must have, or have the ability to acquire within 90 days, the computer systems abilities needed to finish online knowing requirements for job-specific proficiencies, gain access to online types and policies, total online advantages registration, and so on
Renown Health.
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