Health Information Associates

Coding Consultant

US-Remote Office
ID
2015-1017
Category
Review

Overview

Headquartered in Pawleys Island, SC, Health Information Associates (HIA) is a privately held company and was founded in 1992 by Betsy Bailey, RHIA and Deane Beamer, MHA. Prior to 1992, Mrs. Bailey held Director of HIM positions at two (2) hospitals in Virginia. Mr. Beamer had over thirty (30) years of experience as an Administrator working in various hospitals throughout the southeast.

 

Since its inception, HIA has partnered with hundreds of hospitals nationwide to provide customized comprehensive coding compliance reviews and educational services as well as coding support.  HIA has grown to become a highly respected provider due to its ability to adapt to industry changes while maintaining a cohesive and conservative approach. HIA’s attention to individual client needs, from the smallest critical access hospital to the largest healthcare corporation, has led to the type of long term and mutually beneficial partnerships it is fortunate to share with its clients.

 

Responsibilities

  • Review IP DRG denials and write appeal letters when possible
  • Review Discharge Disposition denials and write appeal letters when possible
  • Review OP CPT and/or modifier denials and write appeal letters when possible
  • Perform IP Prebill audits to include ICD-10-CM, ICD-10-PCS and DRG
  • Perform OP Prebill audits to include ICD-10-CM, CPT and APC
  • Perform IP Prebill validation of HAC (hospital acquired condition) POA (present on admission) indicators for Performance Improvement (PI) Referrals
  • Utilize CDI (clinical documentation improvement) clinical validity expertise to assist in writing appeal letters
  • Perform retrospective DRG validation audits for IP data quality
  • Perform retrospective comprehensive IP and/or OP coding audits for data quality  (ICD-9-CM, ICD-9 procedure, POA, DRG, d/c disposition, ICD-10-CM, ICD-10-PCS, CPT, modifier, APC)
  • Communicate with Patient Financial Services and/or Subject Matter Experts (SMEs) as well as Senior Coder and Senior CDI and Coding Manager via email and/or client specific electronic communication
  • Enter demographic data, codes and findings into HIA Compliance database as well as client specific database, when required
  • Perform new coder training audits for IP and OP and communicate with Coding Manager and/or coder directly immediately
  • Generate monthly compliance reports for client site management
  • Generate coder specific reports for Coding Manager
  • Utilize HIA Document Manager Portal to upload and receive files to and from client site
  • Utilize various EHRs and navigate client specific information technology (ex. 3M HDM, 360 Encompass, EPIC, Sorian, ClinTrac, AHEAD, 3M Coding and Reimbursement System encoder)
  • Use HIA Compliance database to collect original coding, recommended coding and payer specific rationale during Appeal or Level 2 Reviews.
  • Perform other IM (interim management) duties as assigned
  • Research internet websites for clinical appeal material
  • Utilize online coding references to include AHA Coding Clinic for ICD-9-CM and ICD-10-CM/PCS, AMA CPT Manual, Official Guidelines for Coding and Reporting, Coding Handbook, Coders’ Desk Reference, AMA CPT Assistant, AHA Coding Clinic for HCPCS, ICD-9-CM Index and Tabular, ICD-9-PCS Index and Table, Clinical Pharmacology Drug Reference, Dorland’s Medical Dictionary, Elsevier’s Anatomy Plates, The Merck Manual, Dr. Z’s Interventional Radiology Reference
  • Reviews quality of coding for DRG revenue assurance, compliance and quality outcomes
  • Performs staff development by providing one-on-one training
  • In-depth working knowledge of regulatory and compliance requirements including RAC process
  • Recommend, write and/or review physician queries
  • Assist in developing coding policies and procedures
  • Answer Coder specific questions
  • Answer Senior CDI questions   

Qualifications

  • RHIA, RHIT, and/or CCS
  • Minimum 5 years inpatient and/or outpatient coding and auditing experience in an acute care facility.
  • I-10-CM/PCS training
  • Computer proficiency, able to research coding questions and utilize HIA’s internal educational resources.
  • High Speed Internet via Cable (no Satellite or wireless cell based)
  • Independent, focused individual able to work remotely.

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