Conducts risk-based coding quality audits and random qualityaudits of ambulatory surgery center (ASC) / same day surgery (SDS) outpatient encounters to validate codeassignment is in compliance with the official coding guidelines as supported byclinical documentation in the health record.
Validates abstracted data elementsthat are integral to appropriate payment methodology. Provides subject matter expertise to codingcompliance concerns and questions.
ESSENTIAL DUTIES ANDRESPONSIBILITIES
Include the following. Others may be assigned.
Understands, interprets and applies codingguidelines for coding audits.
Audits ambulatory surgery center / same daysurgery encounters code assignments.
Review of medical records to determine codingaccuracy of documented diagnoses and procedures.
Reviews claims to validate submitted codes andabstracted data including but not limited to ICD-10 CM codes, CPT codes, and AmbulatoryPayment Classification (APC).
Creates clear and accurate audit findings andrecommendations in written audit reports that will be used for advising andeducating Coders, Auditors, Managers, and Directors throughout theorganization.
Identifies documentation issues (lackingdocumentation, missed physician queries, etc.) that impact codingaccuracy. Clearly communicates (verballyand in written reports or summaries) opportunities for documentation improvementrelated to coding issues.
Stays current with AHA Official Coding andReporting Guidelines, CMS and other agency directives for ICD-10-CM and CPTcoding.
Completes online educationcourses and attends mandatory coding workshops and / or seminars (OutpatientProspective Payment System (OPPS), ICD-
10-CM and CPT updates) for outpatientcoding. Reviews American HospitalAssociation (AHA) and CPT quarterly coding update publications.
Attendsinternal conference calls for Quarterly Coding Updates.
FINANCIAL RESPONSIBILITY (Specify Revenue / Budget / Expense) :
KNOWLEDGE, SKILLS, ABILITIES
To perform this job successfully, an individual must be ableto perform each essential duty satisfactorily. The requirements listed beloware representative of the knowledge, skill and / or ability required.
Reasonableaccommodations may be made to enable individuals with disabilities to performthe essential functions.
Ability to consistently and accurately auditcoding of outpatient (ASC / SDS) encounters
Ability to create clear and concise auditreports and maintain productivity standards
Must successfully pass pre-hire codingassessment
Must successfully pass post-hire initial qualityreview (IQR)
Knowledge of medical terminology and ICD-10 CM / CPT-4coding guidelines and methodologies
Knowledge of disease pathophysiology and drugutilization
Knowledge of APC, Outpatient Code Editor (OCE), NationalCorrect Coding Initiative (NCCI) classification and reimbursement structures
Must be detail oriented and have the ability towork independently
Ability to demonstrate initiative and disciplinein time management and assignment completion
Ability to work in a virtual setting underminimal supervision
EDUCATION / EXPERIENCE
Include minimum education, technical training, and / orexperience preferred to perform the job.
Associates degree in relevant field preferred orcombination of equivalent of education and experience
Three (3) years coding experience including butnot limited to hospital outpatient encounters
One (1) year of experience in coding audit orquality review work including but not limited to hospital outpatientencounters.
REQUIRED CERTIFICATIONS / LICENSURE Include minimum certification required to perform the job.
The physical demands described here are representative ofthose that must be met by an employee to successfully perform the essentialfunctions of this job.
Reasonable accommodations may be made to enableindividuals with disabilities to perform the essential functions.
Must be able to work in sitting position forextended periods
Must be able to efficiently use computer,keyboard and mouse to perform audit work assignments and answer telephone
Duties may require driving an automobile to off-site locations.
Includes ability to walk through hospital-baseddepartments across broad campus settings, including Emergency Departmentenvironments
As a part of theTenet and Catholic Health Initiatives family, Conifer Health brings 30 years ofhealthcare industry expertise to clients in more than 135 local regionsnationwide.
We help our clients strengthen their financial and clinicalperformance, serve their communities and succeed at the business of healthcare.
Conifer Health helps organizations transition from volume to value-based care,enhance the consumer and patient healthcare experience and improve quality,cost and access to healthcare.
Are you ready to be part of our solutions? Welcome to the company that gives you theresources and incentives to redefine healthcare services, with a competitivebenefits package and leadership to take your career to the next step!
Conifer Health Solutions