Conducts risk-based coding quality audits and random quality audits of ambulatory surgery center (ASC)/same day surgery (SDS) outpatient encounters to validate code assignment is in compliance with the official coding guidelines as supported by clinical documentation in the health record. Validates abstracted data elements that are integral to appropriate payment methodology. Provides subject matter expertise to coding compliance concerns and questions.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Include the following. Others may be assigned.
Understands, interprets and applies coding guidelines for coding audits.
Audits ambulatory surgery center/same day surgery encounters code assignments.
Review of medical records to determine coding accuracy of documented diagnoses and procedures.
Reviews claims to validate submitted codes and abstracted data including but not limited to ICD-10 CM codes, CPT codes, and Ambulatory Payment Classification (APC).
Creates clear and accurate audit findings and recommendations in written audit reports that will be used for advising and educating Coders, Auditors, Managers, and Directors throughout the organization.
Identifies documentation issues (lacking documentation, missed physician queries, etc.) that impact coding accuracy. Clearly communicates (verbally and in written reports or summaries) opportunities for documentation improvement related to coding issues.
Stays current with AHA Official Coding and Reporting Guidelines, CMS and other agency directives for ICD-10-CM and CPT coding. Completes online education courses and attends mandatory coding workshops and/or seminars (Outpatient Prospective Payment System (OPPS), ICD-10-CM and CPT updates) for outpatient coding. Reviews American Hospital Association (AHA) and CPT quarterly coding update publications. Attends internal conference calls for Quarterly Coding Updates.
Provides input regarding departmental budget specific to area of responsibility.
KNOWLEDGE, SKILLS, ABILITIES
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Ability to consistently and accurately audit coding of outpatient (ASC/SDS) encounters
Ability to create clear and concise audit reports and maintain productivity standards
Must successfully pass pre-hire coding assessment
Must successfully pass post-hire initial quality review (IQR)
Knowledge of medical terminology and ICD-10 CM/CPT-4 coding guidelines and methodologies
Knowledge of disease pathophysiology and drug utilization
Knowledge of APC, Outpatient Code Editor (OCE), National Correct Coding Initiative (NCCI) classification and reimbursement structures
Must be detail oriented and have the ability to work independently
Computer knowledge of MS Office
Must display excellent interpersonal skills
Ability to demonstrate initiative and discipline in time management and assignment completion
Ability to work in a virtual setting under minimal supervision
EDUCATION / EXPERIENCE
Include minimum education, technical training, and/or experience preferred to perform the job.
Associates degree in relevant field preferred or combination of equivalent of education and experience
Three (3) years coding experience including but not limited to hospital outpatient encounters
One (1) year of experience in coding audit or quality review work including but not limited to hospital outpatient encounters.
Coding compliance experience
ASC/SDS coding/auditing experience
Include minimum certification required to perform the job.
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Must be able to work in sitting position for extended periods
Must be able to efficiently use computer, keyboard and mouse to perform audit work assignments and answer telephone
Ability to travel
Duties may require driving an automobile to off- site locations.
Includes ability to walk through hospital-based departments across broad campus settings, including Emergency Department environments
As a part of the Tenet and Catholic Health Initiatives family, Conifer Health brings 30 years of healthcare industry expertise to clients in more than 135 local regions nationwide. We help our clients strengthen their financial and clinical performance, serve their communities and succeed at the business of healthcare. Conifer Health helps organizations transition from volume to value-based care, enhance the consumer and patient healthcare experience and improve quality, cost and access to healthcare. Are you ready to be part of our solutions? Welcome to the company that gives you the resources and incentives to redefine healthcare services, with a competitive benefits package and leadership to take your career to the next step!
Job: Conifer Health Solutions
Primary Location: Frisco, Texas
Other Locations: San Jose,Atlanta,Philadelphia,Houston,Denver,New York City,Fargo,Cleveland
Job Type: Full-time
Shift Type: Days
Employment practices will not be influenced or affected by an applicantâ��s or employeeâ��s race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship.
Internal Number: 1905018282
About Conifer Health Solutions
“Tenet Healthcare Corporation is a diversified healthcare services company with 115,000 employees united around a common mission: to help people live happier, healthier lives. Through its subsidiaries, partnerships and joint ventures, including United Surgical Partners International, the Company operates general acute care and specialty hospitals, ambulatory surgery centers, urgent care centers and other outpatient facilities. Tenet's Conifer Health Solutions subsidiary provides technology-enabled performance improvement and health management solutions to hospitals, health systems, integrated delivery networks, physician groups, self-insured organizations and health plans.