Performs data quality reviews on inpatient and or outpatient medical records to validate the ICD-9-CM, CPT, and HCPCS Level II code and modifier assignments, APC/DRG group appropriateness.
Ensures compliance with all APC/DRG mandates and outpatient reporting requirements.
Prepares quality and productivity statistics for the inpatient/outpatient coders according to facility and or Company guidelines and protocols
Provides on-going training to the inpatient/outpatient coding staff based on quality findings and regulatory changes in the OPPS system.
Develops reports and collects and prepares data for studies involving outpatient encounter data for clinical evaluation purposes and/or financial impact and profitability.
Performs periodic claim form reviews to check code transfer accuracy from the abstracting system and the chargemaster.
- High School Diploma or General Education Degree Required, Graduation from accredited HIM program preferred.
- Minimum of 5+ years recent auditing experience in a hospital setting.
- Must have experience in regulatory issues related to Medicare and other third party payers as is relates to hospital coding and billing
- Require RHIA, RHIT and /or CCS
- Knowledge of Official Guidelines for Coding and Reporting, High level of competence in coding APC and current with CPT guidelines.
- Knowledge of MS-DRGs and reimbursement methods for Medicare, CHAMPUS, Medicaid, other payers
- Familiar with charge master and use of CDM for reference
- Knowledge of medical terminology, anatomy, physiology, and pharmacology.
- Knowledge and support of the Company corporate compliance initiatives
- Clinical knowledge gained through education or experience
- Proficient computer keyboarding skills and basic computer knowledge including MS Word
- If working remote must have recent remote experience
- Computer literacy of encoder applications, medical record hospital information system applications, Access, Excel, Windows, Power Point, etc.
- Must be able to present the statistical activities/data, which are necessary for committee/administration analysis.
- Must be able to organize, direct, and participate in the compilation and analysis of data and submit specified hospital, physician patient information to authorized groups or committees. Demonstrates interpersonal and communication skills.
- Prefer someone with past auditing experience or strong training background in coding and reimbursement.
WE WANT YOU ! This is an outstanding opportunity to join our industry leading Auditing team. We remain a fast growing Company looking to add the top industry talent to our team. We offer an outstanding compensation package that includes competitive wages, affordable benefits, education allowance and monthly webinars in addition to ICD 10 training and education. Huge opportunity for career advancement. Contact Us Today !