CODING INT OVERSIGHT ALYST

Job Summary :

The Coding Integrity Oversight Analyst plays a crucial role in ensuring the accuracy, completeness, and integrity of clinical documentation, which is vital for quality patient care, regulatory compliance, and proper reimbursement. This position contributes significantly to the overall quality and efficiency of healthcare delivery within the organization. This person will be performing coding validation audits on Medicare and Medicare replacement inpatient stays in accordance with Medicare’s value-based purchasing quality initiatives 30-day readmission rates and mortality rates. They will also assist in writing appeals on DRG downgrade denials.

Performance Expectations :

• Documentation Review & Analysis : Review medical records to identify documentation gaps and ensure accuracy regarding patient severity and risk of mortality. Identify areas for improved specificity.
• Collaboration & Communication : Work with coding and CDI teams to clarify and improve documentation, communicate findings, and resolve issues.
• Compliance & Reimbursement : Ensure documentation adheres to regulations and policies. Optimize documentation for accurate coding and reimbursement. Track queries and assist with denials / appeals.
• Working Knowledge of ICD-10-CM, ICD-10-PCS, CPT and HCPCS coding systems
• Maintain accurate knowledge of coding compliance and reimbursement procedures
• Strong knowledge of diagnosis coding and HCC documentation requirements
• Working knowledge of Zoom and Microsoft teams
• Must work on site full time.
• Experience with Microsoft applications (Word, Excel, Power point and Outlook

Qualifications

Education & Certification

Licensure

Skills

Desired traits

Experience

Mental Demands :

Exceptional oral and written skills are required to relate effectively to Hospital staff, medical staff, and

Regulatory agencies. The individual must have a high energy level and be capable of handling pressure

situation both mentally and physically. Knowledge of DNV Standards and other regulatory agency requirements is essential. Exceptional analytical skills are necessary to perform required data analysis.

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