POSITION SUMMARY
Conducts inpatient coding quality audits to validate code assignment is supported by clinical documentation in the medical record.
Highly proficient in the proper assignment of ICD-10-CM and PCS codes.
KEY RESPONSIBILITIES :
- Performs coding audits of a wide variety of complex inpatient records to validate the ICD-10-CM, PCS codes, MS-DRG and / or APR DRG assignments.
- Provides written, detailed rationale and supporting evidence for recommendations on audit findings.
- Delivers educational feedback to coding staff regarding audit findings.
- Provides guidance to coding staff and management in identifying and resolving coding issues.
- Identifies documentation improvement opportunities that impact coding accuracy.
- Initiates physician queries for clarification of documentation in the medical record to achieve accurate code assignment.
- Collaborates with the clinical documentation improvement team for conflicts between code assignments.
- Reviews and researches billing edits.
- Assists with DRG denials from payers including researching and writing appeal letters.
- Ability to interpret Medicare and NCCI guidelines, National and Local Coverage Determinations to support coding compliance.
- Maintains a minimum of 95% accuracy on all coding audits.
- Maintains productivity standard of approximately 20 inpatient coding reviews per day.
- Performs other duties as assigned including training / mentoring of new staff and performing research related to special projects
REQUIRED KNOWLEDGE & SKILLS :
Examples : Ability to work independently and take initiative; Good judgment and problem solving skills; Communication skills;
Interpersonal and organizational skills; Level of confidentiality)
- Comprehensive understanding of coding guidelines, Coding Clinics and appropriate coding references along with the ability to employ these coding resources to audit findings.
- Excellent interpersonal verbal and written communication skills to accurately relay information to internal and external customers.
- Excellent organizational skills with ability to trend and track audit findings effectively.
- Excellent problem solving skills, the ability to work independently, and to perform under pressure in a teamwork manner with diplomacy and tact.
- Proficient computer and technical skills, along with experience using MS Word, Excel and PowerPoint.
- Ability to meet assigned deadlines.
EDUCATION / EXPERIENCE / LICENSURE / TECHNICAL / OTHER :
I. Education : Associates degree in Health Information (RHIT), or associates degree in applicable healthcare field.
II. Experience 3-5 years progressive coding experience in acute care hospital setting, including auditing
III. Certification / Licensure : AHIMA certification required, such as RHIA, RHIT or CCS,
IV. Software / Hardware : Meditech and 3M 360 experience required; Cerner experience helpful.
V. Other : This is a remote position, and must live within a Steward hiring state.
VI. Travel : Expected travel is up to 10%. Education and / or company growth.
About Steward Health Care
Over a decade ago, Steward Health Care System emerged as a different kind of health care company designed to usher in a new era of wellness.
One that provides our patients better, more proactive care at a sustainable cost, our providers unrivaled coordination of care, and our communities greater prosperity and stability.
As the country's largest physician-led, minority-owned, integrated health care system, our doctors can be certain that we share their interests and those of their patients.
Together we are on a mission to revolutionize the way health care is delivered - creating healthier lives, thriving communities and a better world.
Based in Dallas, Steward currently operates more than 30 hospitals across Arizona, Arkansas, Florida, Louisiana, Massachusetts, Ohio, Pennsylvania, and Texas.