Facility Coding Quality Specialist

About Us

Our purpose is to help clients exceed their financial health goals. Across the reimbursement cycle, our scalable solutions and clinical expertise help solve programmatic needs. Enabling our teams with leading technology allows analytics to guide our solutions and keeps us accountable achieving goals. We build long-term careers by investing in YOU. We seek to create an environment that cultivates your professional development and personal growth, as we believe your success is our success.

Job Summary

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Performs complex retrospective analysis of medical record documentation to identify coding and billing errors and inconsistencies according to guidelines of the AHA, CMS, AMA, Clinic Coding Clinic and CPT Assistant.
• Analyzes audit findings to identify potential root causes of coding errors and prevent their reoccurrence.
• Provides second-level review of diagnosis, procedure and billing codes to ensure compliance with legal and procedural policies that ensure optimal reimbursements while adhering to regulations prohibiting unbundling and other questionable practices.
• Researches, analyzes and responds to inquiries regarding compliance, inappropriate coding, denials and billable services.
• Provides technical support and feedback training to internal coding staff regarding coding compliance, documentation, regulatory provisions, third party payer requirements, medical necessity requirements.
• Protects the privacy and confidentiality of patient health and client information.
• Follows the Standards of Ethical Coding as set forth by AHIMA and adheres to official coding guidelines and compliance practices.
• Suggests physician query opportunities query Physicians based upon documentation and clinical needs.
• Prepares deliverables for the coders as required.
• Reports work time and work productions in a timely and accurate manner.
• Communicates with coworkers in an open and respectful a manner which promotes teamwork and knowledge sharing.
• Provides schedule of planned work activities, events and sites, and any changes to same to management and appropriate staff.
• Maintains professional coding credentials and knowledge of coding, reimbursement methodologies and compliance issues through education.
• Maintains QA percentages within two internal quality goals; 1) overall minimum coder accuracy of 95% and 2) QA review percentages as close to 10% as possible.
• Identifies and resolves coding quality problems or issues in a timely manner.
• Maintains a continual knowledge of problems or issues that could affect coding quality levels.
• Aids in design of systems to help improve coder productivity and assists in improving accuracy of coding.
• Provides monthly reports.
• Participates in corporate training and meetings.
• Provides status reports to senior manager as requested.
• Aligns conduct with AHIMA's Standards of Ethical Coding and the Company’s Code of Ethics and Business Conduct and supports the Company’s Ethics and Compliance Program.
• Interprets coding guidelines for accurate code assignment.
• Identifies the importance of documentation on code assignment and the subsequent reimbursement impact.
• Complies with all internal policies and procedures.
• Actively participates in Company provided training and education.
• Ensures individual compliance with all privacy and security rules and regulations and commits to the protection of all Company confidential information, including but not limited to, Personal Health Information.
• Facilitates Facility IP/OP auditing and coding experience.

Qualifications and Requirements

• Regular, predictable and punctual attendance is required.
• Strong Verbal And Written Communication Skills Are Required.
• Ability to prioritize workload, meet deadlines and maintain a high level of quality and accuracy.
• Recognized coding credential from AHIMA or AAPC; and RHIA or RHIT may also be considered.
• Experience with telecommuting and electronic medical records systems strongly preferred.
• Strong analytical skills.
• Excellent written communication skills.
• Strong team player.
• Ability to work with multiple and diverse clients and projects.
• Ability to work with minimal supervision.
• Minimum 2 years (Preferrably 3 years) experience coding and/or auditing in an Inpatient and Outpatient facilities.
• Initiative, resourcefulness and attention to detail.
• Coding Certification -- preferred (CPC or CCS).
• Strong communication skills, proficient in Microsoft Office applications including Word and Excel.
• Familiarity with hospital outpatient billing processes.
• Understand hospital APC assignment and associated coding and documentation.
• Physical Demands: Regular eye-hand coordination and manual dexterity is required to operate office equipment. The ability to perform work at a computer terminal for 6-8 hours a day and function in an environment with constant interruptions is required. At times, Team Members are subject to sitting for prolonged periods. Infrequently, Team Member must be able to lift and move material weighing up to 20 lbs. Team Member may experience elevated levels of stress during periods of increased activity and with work entailing multiple deadlines.