Clinical Coding Analyst (Remote)

Except CA and NY Job Summary : The Remote Medical Coding Analyst is responsible for conducting pre-billing reviews of inpatient charts specifically for MS DRG assignment.

The analyst will identify potential areas of increased revenue and ensure compliance with the Official ICD-10-CM / PCS Guidelines for Coding and Reporting, AHA Coding Clinics, disease processes, procedure recognition, and clinical knowledge.

If you possess the following qualifications, you would be a great fit for this role :

• You must have AHIMA credentials such as CCS, CDIP, or ACDIS credentials like CCDS. AHIMA Approved ICD-10 CM / PCS Trainer certification is preferred.
• You are a graduate of an accredited Health Information Technology or Administration program and have AHIMA credentials of RHIT or RHIA (preferred).
• You have a minimum of 7 years of experience in acute inpatient hospital coding, auditing, and / or CDI. This experience must be from a large tertiary hospital.
• Experience with CDI (Clinical Documentation Improvement) programs is preferred.
• You possess extensive knowledge of ICD-10 CM / PCS.
• Familiarity with electronic health records such as Cerner, Meditech, or Epic is required.
• Previous experience working remotely is necessary.
• Excellent communication skills, both written and verbal, are required.
• You must demonstrate exceptional analytical ability, initiative, and resourcefulness.
• The ability to work independently is essential.
• Strong planning and organizational skills are necessary.
• You should be a team player and demonstrate flexibility in your work approach.
• Proficiency in Microsoft Office Word and Excel programs is a must.

Essential Job Duties and Responsibilities :

• As a Clinical Coding Analyst, you will be assigned to specific client(s) and will be responsible for conducting daily pre-bill chart reviews and communicating the findings to the client(s) within 24 hours.
• You will provide daily client volumes to the Audit Manager by 7 am EST.
• Conduct reviews of electronic health records to identify potential revenue opportunities and coding compliance issues based on ICD-10-CM / PCS coding rules, AHA Coding Clinics, and clinical knowledge.
• Before submitting recommendations to the client, you will have verbal discussions with the Company Physician(s) regarding potential MS DRG recommendations and / or physician query opportunities.
• Ensure that the daily work list is uploaded into the MS DRG Database for the assigned client(s) and enter all required data elements for each patient recommendation into the database.
• Prepare and compose recommendations including increased or decreased reimbursement and "FYI" notes for each account. Communicate these findings to the client within 24 hours of reviewing the electronic medical record.
• Respond to client questions and rebuttals within 24 hours of receipt, following internal protocols.
• Review and appeal Medicare and / or third-party denials on charts processed through the MS DRG Assurance program, if necessary.
• Review inclusions and exclusions related to 30 Day Readmissions and Mortality quality measures for specific cohorts and traditional Medicare payers for designated clients.
• Maintain access to IT systems at all assigned client sites by ensuring logins and passwords are up to date.
• Stay up to date with ICD-10-CM / PCS code changes, AHA Coding Clinics, and Medicare regulations.
• Utilize internal resources such as TruCode, I10 Wiki, and CDocT as needed.
• Adhere to all company policies and procedures.

Schedule : You have the flexibility to choose your work hours, but all Clinical Coding Analysts are required to report daily client volumes to the Audit Manager by 7 am EST for appropriate assignment.

Our company typically operates from 8 am-5 pm EST / CST. You will schedule daily meetings with the Physician team and are free to choose the preferred times within the Physician team's availability, which is between 7 : 30 am-6 pm EST.

It is ideal for your work schedule to align within this timeframe. Home Office Requirements :

• An essential requirement is a high-speed internet connection and a dedicated, secure workspace to maintain compliance with HIPAA Privacy and Security policies and procedures when accessing and viewing protected health information (PHI).
• The company will provide you with a laptop and access to the necessary resources for performing your job duties.

Interview Process :

• Case Study Skills Assessment (PCS Coding and Clinical Validation)
• Video Call with Audit Manager / Team Lead (1 hour)
• Video Call for Verbal Case Study Discussion (1 hour)
30+ days ago