SummaryDevelops, implements, and maintains a coding and reimbursement quality management plan at the network level. Utilizes output for financial and billing purposes to meet licensure requirements, network quality initiatives, statistics, and for public hospital and physician reporting.
Job Duties- Conducts formal education and training for staff on policies/procedures, coding guidelines, regulatory requirements, and work processes. Provides feedback and develops educational action plans.
- Performs code monitoring and auditing activities providing individual, departmental, and topic related results according to established schedule.
- Researches and responds to coding questions from staff.
- Evaluates the quality of clinical documentation to spot incomplete or inconsistent documentation impacting code selection. Anticipates documentation issues in response to upcoming regulatory updates.
- Maintains database for internal reporting of quality outcomes.
- Establishes, implements, and maintains a formalized review process to support coding compliance.
Minimum Qualifications- Associate's Degree in health information management program or work experience in a complex coding environment, equivalent to Associates Degree.
- 4 years of experience coding/abstracting of complex provider-based patient encounters.
- Expert knowledge of ICD-10CM, HCPCS/CPT coding, modifiers, and reimbursement methodologies (wRVUs).
- Microsoft Office and presentation skills.
- CCA - Certified Coding Associate AHIMA - State of Pennsylvania Upon Hire or
- CCS - Certified Coding Specialist AHIMA - State of Pennsylvania or
- CCS-P - Certified Coding Specialist-Physician Based AHIMA - State of Pennsylvania or
- CPC - Certified Professional Coder - State of Pennsylvania or
- CPC-H-Certified Professional Coder-Hospital AAPC - State of Pennsylvania
Preferred Qualifications- Bachelor's Degree in health information management program.
- 1 year of experience auditing of provider-based coding and
- 1 year of experience in provider-based coder training.
- Auditing and training.
- Knowledge of medical terminology, anatomy and physiology, pathophysiology, regulatory agency requirements, severity of illness classification, and health care statistics computation.
Physical DemandsLift and carry 25 lbs. frequent sitting/standing, frequent keyboard use, *patient care providers may be required to perform activities specific to their role including kneeling, bending, squatting and performing CPR.
Job Description Disclaimer: This position description provides the major duties/responsibilities, requirements and working conditions for the position. It is intended to be an accurate reflection of the current position, however management reserves the right to revise or change as necessary to meet organizational needs. Other responsibilities may be assigned when circumstances require.
Work Shift:Day Shift
Address:1200 S Cedar Crest Blvd
Primary Location: REMOTE IN PENNSYLVANIA
Position Type:Remote
Union:Not Applicable
Work Schedule:Department:1004-13044 COH-Risk Adjustment Coding
