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Overview
The Coding Integrity Specialist (CIS, Sr.) is accountable for providing instructional workshops and/ or material to all medical care practices related to Independent Health. The CIS, Sr. will likewise be accountable for the targeted shipment of info to medical care practices who have actually been recognized through efficiency reports as having substantial enhancement chances.( Propose erasing – The CIS, Sr. is accountable for multi-channel education consisting of, however not restricted to, in person supplier education, that includes on-site coding (HCC and CRG) and documents education of recognized company workplaces, usage of the EMR to help in suitable coding and documents or other essential education on HCC and CRG coding that is required. The CIS, Sr. will likewise advance to practice supervisor( s) any problems or issues recognized in the practices. The CIS, Sr. will likewise be accountable for the practice application of the detailed procedure focused on utilizing metrics to enhance the service provider practice scorecard in the locations of coding and paperwork. The senior professional is likewise accountable for helping in the claims evaluation, medical record capture and evaluation, and recognition of the one finest record to validate CMS HCC submission as appointed per CMS RADV audit requirements. The senior professional will help the supervisor in training coding stability partners and supply training and mentoring as required.
Qualifications
Associate’s degree needed; Bachelor’s degree chosen; an extra 2 (2) years of medical record auditing, with a concentrate on ICD-9 and ICD-10 coding confirmation might be thought about in lieu of degree. RHIA or RHIT degree chosen.
AHIMA (CCS-P) or AAPC (CPC) accreditation needed.
Four (4) years of current experience in medical record auditing, with a concentrate on ICD-9 and 10 coding confirmation needed.
Experience with in person supplier workplace education needed.
Experience in medical record auditing for potential or retrospective CMS HCC catch chosen.
Proven understanding of recognized paperwork and coding standards based on CMS/AMA requirements.
Demonstrated analytical and crucial thinking abilities, with the capability to use understanding of coding standards to evaluate clinical/claims information and recognize chances for intervention.
Demonstrated outstanding spoken, written and social interaction abilities with the capability to successfully interact with both internal and external consumers in an expert way every day.
Ability to prepare quantitative and qualitative summary reports at the conclusion of medical record audits.
Demonstrated strong organizational abilities, with the capability to successfully handle practice audit/education work.
Demonstrated experience using independent judgment to render choices.
Demonstrated time management abilities, with the capability to operate in a self-directed, self-governing way.
Demonstrated PC/Windows abilities with efficiency in Microsoft Word, Excel and Powerpoint needed.
Local travel needed. Any Independent Health partner who utilizes an automobile in the course of their tasks representing Independent Health should be certified with New York State Motor Vehicle laws and need to follow the Policy that refers to Driver’s License Requirements as a condition of work.
Ability to work a versatile schedule needed.
Proven examples of showing the IH worths: Passion, Caring, Trustworthy, Collaborative, Respectful and Accountable.
Essential Accountabilities
The CIS, Sr. will be accountable for the targeted shipment of info to medical care practices who have actually been determined through efficiency metrics reports as having substantial enhancement chances Responsible for the shipment of multi-channel education of determined service provider workplaces on coding and paperwork as it connects to record of HCCs or CRGs, usage of the EMR to help in suitable coding and documents, adjusting pre-visit preparation strategies to proper capture HCCs or CRGs, or other relevant education on coding that is required.
Responsible for the practice application of the detailed procedure targeted at utilizing metrics to enhance company practice scorecard in the locations of coding and paperwork.
Bring forward to practice supervisor( s) any problems or issues recognized in the practices.
Answer intensified call from maintenance and/or companies or workplace personnel to resolve concerns about coding and paperwork or offer feedback on audit results when shown.
Responsible for internal medical record evaluations from faxed in, sent by mail in, or emailed medical records, and practice-based medical record evaluations of the electronic medical record or paper record, to determine HCC or CRG codes, and the recognition of missing out on crucial spaces in care, in accordance with paperwork & coding requirements and medical practice standards.
Keep a log of all records examined, with member and service provider recognizing info, any HCCs discovered, and whether crucial spaces in care were resolved at the time of the workplace go to, along with any extra instructional chances discovered while examining the record.
Analyze claims submission and RAPS information from an IBM Cognos database to determine locations of chance for which to examine medical records in the supplier network to discover income creating medical diagnosis codes (HCC’s).
Create weekly Risk Adjustment Payment submission (RAPS) file( s) of missing out on HCC codes discovered from medical record evaluates that are then sent to CMS for extra payment.
Maintain an on-going, versatile expert working relationship with the company workplaces in the neighborhood that have actually been appointed per practice supervisor.
Assist in the claims evaluation, medical record capture and evaluation, and recognition of the one finest record to validate CMS HCC submission as appointed per CMS RADV audit requirements.
Assist the supervisor in training and carrying out quality control audits of coding stability partners. Supply training and mentoring as required.
As an Equal Opportunity/ Affirmative Action Employer, Independent Health and its affiliates will not discriminate in its work practices due to a candidate’s race, color, creed, faith, sex (consisting of pregnancy, giving birth or associated medical conditions), sexual preference, gender identity or expression, transgender status, age, nationwide origin, marital status, citizenship, physical and psychological impairment, rap sheet, hereditary details, predisposition or provider status, status with regard to getting public support, domestic violence victim status, a handicapped, unique, just recently separated, active service wartime, project badge, Armed Forces service medal veteran, or any other qualities safeguarded under appropriate law. for extra EEO/AAP or Reasonable Accommodation info.
Current Associates need to use internally through their Career Worklet.
Independent Health.
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