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Coding Reimbursement Auditor

Company: Renown Health
Location: Reno
Posted on: January 15, 2020

Job Description:

Position Purpose:

This position is responsible for the coordination of quality audits for coding staff. In addition, this position is responsible for auditing as part of the Coding Reimbursement Team and the reporting of audit results to Leadership.

The emphasis of this position is to coordinate all aspects of audit entities, including outside request for compliance and billing, including and not limited to RAC and/or other auditing programs audit requests.

This position is responsible to maintain departmental policies set forth by Leadership and keeping abreast of continual changes in coding and billing guidelines and compliance related to reimbursement within federal and State regulations. This incumbent is to have expert knowledge of accurately assigning ICD-9-CM/ICD-10-CM diagnostic and procedure codes for all aspects of facility coding. This list is to include Acute Inpatient, Level II Trauma, Rehab Facility, Skilled Nursing, Home Health as well as Hospice. ICD-9-CM/ICD-10-CM/PCS and CPT code assignments must be consistent with CMS Official Guidelines, regulatory agencies and hospital specific bylaws and guidelines.

Nature and Scope:

The major challenge of this position is to coordinate the coding staff auditing schedules for quality and proficiency to ensure compliance of Coding/Auditing, Coding and documentation quality, and that accurate reimbursement is being met with quality coding standards. This position is accountable for auditing information coded from provider documentation and patient medical records within the designated time frames in order to expedite the billing process ensure accurate reimbursement for services rendered and to promote compliance.

All findings obtained in the auditing arena must be documented and reported to Coding and Financial Leadership.

This position has access to proprietary information and has contact with external organizations, which mandates high standards of professionalism, communication, performance, and respect for confidentiality. This position is challenged to be aware of the continual changes in Federal and State regulations.

This position is accountable to maintain departmental policies and bring issues and the need for revised/additional policies and procedures to management's attention.

This person must be able to identify and resolve problems, set goals and priorities, and represent the department in a professional manner as well as in the absence of Leadership, as assigned.

High standards of performance, courteousness, diplomacy, and respect for confidentiality are essential.

Job responsibilities can include assignment of diagnostic codes by proficient analysis and translation of diagnostic statements, physician orders, and other pertinent documentation leading to coding accuracy and abstracting of pertinent data elements from documentation provided.

The foregoing description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills and efforts or work conditions associated with the job. It is intended to be an accurate reflection of the general nature and level of the job.

Incumbent must have skill set to:


  • Address appeals and review needed information for insurance denials to facilitate expedient resolution and reimbursement.
  • Participates in mandated Medical Record Review processes.


    • Interprets and applies American Hospital Association (AHA) Official Coding Guidelines to articulate and support appropriate principal, secondary diagnoses and procedures.


      • Insures that all factors necessary for assigning accurate DRG are present, and that related diagnoses are ranked properly.
      • Assign accurate present on admission indicators.
      • Provides information and responds to inquiries regarding medical documentation and DRG's to CDI staff including Utilization and Quality Assurance Departments when needed.
      • Knowledge of discharge disposition and reimbursement outcomes.


        Other responsibilities include:


        • Adherence to Health Information Management (HIM) Coding policies.
        • Adherence to The Joint Commission (TJC) and other third party documentation guidelines in an effort to continually improve coding quality and accuracy.
        • Responsibility for maintaining coding certification and referencing current ICD-9/ ICD-10 coding guidelines and regulatory changes.
        • Participates in performance improvement initiatives as assigned.


          The incumbent must consistently meet or exceed productivity and quality standards as defined by the HIM Coding Leadership.

          Telecommuting is allowed with approval from HIM Management.

          KNOWLEDGE, SKILLS & ABILITIES

        • Expert knowledge and specific details of coding conventions and use of coding nomenclature consistent with CMS' Official Guidelines for Coding and Reporting ICD-9-CM/ ICD-10-CM coding.
        • Incumbent must have thorough knowledge of Anatomy and Physiology of the human body, Disease Pathology, and Medical Terminology in order to understand the etiology, pathology, symptoms, signs, diagnostic studies, treatment modalities, and prognosis of diseases and procedures performed.
        • Accurate translation of written diagnostic descriptions to appropriately and accurately assign ICD-9-CM/ ICD-10-CM diagnostic codes and procedural codes to obtain optimal reimbursement from all payer types, including Medicare/Medicaid, and private insurance payers.
        • Ability to troubleshoot Epic Coder queues and Optum workflows to report issues to HIM Coding Leadership.
        • Knowledge of clinical content standards.
        • Ability and knowledge of the appeal process to ensure accurate reimbursement.

          This position does not provide patient care.

          The foregoing description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills and efforts or work conditions associated with the job. It is intended to be an accurate reflection of the general nature and level of the job.

          Minimum Qualifications: Requirements - Required and/or Preferred

          Education:

          Must have working-level knowledge of the English language, including reading, writing and speaking English. Bachelors Degree in Health Information Management is preferred.

          Experience:

          A minimum of 4 or more years of progressively responsible and advanced experience in healthcare coding. Experience in all patient types as well as experience and knowledge of needed compliance criteria for all facility types is required.

          License(s):

          None

          Certification(s):

          CCS or RHIA/RHIT with a minimum of four years of facility coding experience is required

          Computer / Typing:

          Must possess, or be able to obtain within 90 days, the computers skills necessary to complete online learning requirements for job-specific competencies, access online forms and policies, complete online benefits enrollment, etc.

Keywords: Renown Health, Reno , Coding Reimbursement Auditor, Accounting, Auditing , Reno, Nevada

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