Health Information Associates

  • Coding Consultant

    Job Locations US-Remote Office
    ID
    2015-1017
    Category
    Review
  • Overview

     

    Performs compliance audits of Inpatient and Outpatient medical records in accordance with all coding guidelines.  Writes and presents concise recommendation worksheets with appropriate findings and coding references to coders during education exits.  Writes Executive Summaries and must communicate with different administrative levels within the hospital.  Utilizes HIAcompliance. Requires some travel.

    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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