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Profee Coding Quality Specialist
Location
United States
Posted
3 days ago
Salary
0
Seniority
Mid Level
No structured requirement data.
Job Description
Profee Coding Quality Specialist
CorroHealth
Role Description Performs complex retrospective analysis of medical record documentation to identify coding and billing errors and inconsistencies according to guidelines of the AHA, CMS, AMA, Clinic Coding Clinic and CPT Assistant. - Analyzes audit findings to identify potential root causes of coding errors and prevent their reoccurrence. - Provides second-level review of diagnosis, procedure and billing codes to ensure compliance with legal and procedural policies that ensure optimal reimbursements while adhering to regulations prohibiting unbundling and other questionable practices. - Researches, analyzes and responds to inquiries regarding compliance, inappropriate coding, denials and billable services. - Provides technical support and feedback training to internal coding staff regarding coding compliance, documentation, regulatory provisions, third party payer requirements, medical necessity requirements. - Protects the privacy and confidentiality of patient health and client information. - Follows the Standards of Ethical Coding as set forth by AHIMA and adheres to official coding guidelines and compliance practices. - Suggests physician query opportunities based on documentation and clinical needs. - Prepares deliverables for the coders as required. - Reports work time and work productions in a timely and accurate manner. - Communicates with coworkers in an open and respectful manner which promotes teamwork and knowledge sharing. - Provides schedule of planned work activities, events and sites, and any changes to management and appropriate staff. - Maintains professional coding credentials and knowledge of coding, reimbursement methodologies and compliance issues through education. - Monitors the ongoing progress and success of each coder. - Maintains QA percentages within two internal quality goals: - Overall minimum coder accuracy of 95% - QA review percentages as close to 10% as possible. - Identifies and resolves coding quality problems or issues in a timely manner. - Maintains continual knowledge of problems or issues that could affect coding quality levels. - Assists in design of systems to help improve coder productivity and assist in improving accuracy of coding. - Provides monthly reports. - Participates in corporate training and meetings. - Provides status reports to senior manager as requested. - Aligns conduct with AHIMA's Standards of Ethical Coding and the Company’s Code of Ethics and Business Conduct and supports the Company’s Ethics and Compliance Program. - Interprets coding guidelines for accurate code assignment. - Identifies the importance of documentation on code assignment and the subsequent reimbursement impact. - Complies with all internal policies and procedures. - Actively participates in Company provided training and education. - Ensures individual compliance with all privacy and security rules and regulations and commits to the protection of all Company confidential information, including but not limited to, Personal Health Information. Qualifications - Regular, predictable and punctual attendance is required. - Strong verbal and written communication skills are required. - Ability to prioritize workload, meet deadlines and maintain a high level of quality and accuracy. - Recognized coding credential from AHIMA or AAPC; RHIA or RHIT may also be considered. - Experience with telecommuting and electronic medical records systems strongly preferred. - Strong analytical skills. - Excellent written communication skills. - Strong team player. - Ability to work with multiple and diverse clients and projects. - Ability to work with minimal supervision. - Minimum 3 years of Profee coding experience and/or auditing in an acute care facility or multispecialty clinics. - Initiative, resourcefulness and attention to detail. - Customer service support -- minimum one (1) year experience. - Familiarity with hospital outpatient billing processes. - Understand hospital APC assignment and associated coding and documentation. - Coding Certification -- preferred (CPC or CCS). - Strong communication skills, proficient in Microsoft Office applications including Word and Excel. - Ability to navigate in a variety of EMR environments and review hand-written charts. Physical Demands Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions as described. Regular eye-hand coordination and manual dexterity is required to operate office equipment. The ability to perform work at a computer terminal for 6-8 hours a day and function in an environment with constant interruptions is required. At times, Team Members are subject to sitting for prolonged periods. Infrequently, Team Member must be able to lift and move material weighing up to 20 lbs. Team Member may experience elevated levels of stress during periods of increased activity and with work entailing multiple deadlines.
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