Senior Edit Coder - Remote
To see similar active jobs please follow this link: Remote Healthcare jobs
Description:
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 SUMMARYThis position will be functioning under the Manager. This position will assist manager and supervisor in training new team members, coordinate queries from ancillary departments regarding DNFB and edit tasks. The Sr. Edit Coder will investigate and solve edit issues and communicate root cause data to management to solve problems upstream and downstream in a professional manner. Responsible for modifying and completing moderate to high complexity coding and charging edits/errors using ICD-10-CM, CPT and HCPCS or any other designated coding classification system in accordance with coding rules and regulations. Abides by the Standards of Ethical Coding as set forth by AHIMA. Abstracting required clinical information from the medical record. Working in Bill Scrubber systems a requirement.ESSENTIAL DUTIES AND RESPONSIBILITIESInclude the following. Others may be assigned.
- Performs data quality reviews on outpatient encounters to validate the ICD-10-CM, CPT, and HCPCS Level II code and modifier assignments, APC group appropriateness, missed secondary diagnoses and/or procedures, and ensure
- compliance with all APC mandates and outpatient reporting requirements. Monitors medical visit code selection by departments against facility specific criteria for appropriateness. Assists in the development of such criteria as needed. Monitors facility CRC reports for prebill edits related to APC. Addresses CCI and LCD edits within the various billing scrubbers while abiding by the Standards of Ethical Coding as set forth by the American Health Information Management Association. Meets and/or exceeds Conifer s APC specialist productivity standards.
- Runs reports, reviews data and identifies opportunities or trends. Can define DNFB and use data to drive results. Ability to dissect data and display and communicate data in meaningful manner. Ability to maneuver thru various electronic systems effectively.
- Ability to deal with customer/partner issues and resolve conflict. Ability to multi-task and meet deadlines. Will help editors with non-complex edit questions.
- Reviews claim denials in comparison with medical records for the determination of accurate assignment of all documented diagnoses and procedures adhering to the standards of ethical coding.
- Monitors inpatient and outpatient unbilled accounts report for outstanding and/or uncoded outpatient encounters to reduce accounts receivable days for outpatients. Brings identified issues to department managers for resolution.
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.
- RHIA, RHIT or CCS required
- Three years minimum hospital outpatient coding/edit experience
- Advanced personal computing skills including MS Outlook, MS Word, MS Excel
- Advanced technical skills required to learn and navigate a variety of software systems, trouble-shoot computer problems, install periodic updates to software programs and work efficiently in a virtual environment
- Strong written and verbal communication skills
- Ability to think/work independently, yet interact positively with team
- Advanced problem-solving skills and ability to quickly analyze a situation.
- Comprehensive knowledge of ICD-10 and CPT coding systems.
- Strong knowledge base of changes in LCDs and NCDs.
- Strong knowledge base of current NCCI and OCE guidelines
- Attention to detail is crucial to this position.
- Other functions as deemed necessary to complete and final bill claims accurately
- Previous auditing experience or strong training background in coding and reimbursement
- Outstanding interpersonal communication skills as well as excellent oral and written communication skills
- Comprehensive knowledge of the APC structure and regulatory requirements.
- Knowledge of medical terminology, anatomy and physiology, disease process, and surgical procedures
- RHIA, RHIT or CCS required
Senior Edit Coder - Remote
To see similar active jobs please follow this link: Remote Healthcare jobs
Description:
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 SUMMARYThis position will be functioning under the Manager. This position will assist manager and supervisor in training new team members, coordinate queries from ancillary departments regarding DNFB and edit tasks. The Sr. Edit Coder will investigate and solve edit issues and communicate root cause data to management to solve problems upstream and downstream in a professional manner. Responsible for modifying and completing moderate to high complexity coding and charging edits/errors using ICD-10-CM, CPT and HCPCS or any other designated coding classification system in accordance with coding rules and regulations. Abides by the Standards of Ethical Coding as set forth by AHIMA. Abstracting required clinical information from the medical record. Working in Bill Scrubber systems a requirement.ESSENTIAL DUTIES AND RESPONSIBILITIESInclude the following. Others may be assigned.
- Performs data quality reviews on outpatient encounters to validate the ICD-10-CM, CPT, and HCPCS Level II code and modifier assignments, APC group appropriateness, missed secondary diagnoses and/or procedures, and ensure
- compliance with all APC mandates and outpatient reporting requirements. Monitors medical visit code selection by departments against facility specific criteria for appropriateness. Assists in the development of such criteria as needed. Monitors facility CRC reports for prebill edits related to APC. Addresses CCI and LCD edits within the various billing scrubbers while abiding by the Standards of Ethical Coding as set forth by the American Health Information Management Association. Meets and/or exceeds Conifer s APC specialist productivity standards.
- Runs reports, reviews data and identifies opportunities or trends. Can define DNFB and use data to drive results. Ability to dissect data and display and communicate data in meaningful manner. Ability to maneuver thru various electronic systems effectively.
- Ability to deal with customer/partner issues and resolve conflict. Ability to multi-task and meet deadlines. Will help editors with non-complex edit questions.
- Reviews claim denials in comparison with medical records for the determination of accurate assignment of all documented diagnoses and procedures adhering to the standards of ethical coding.
- Monitors inpatient and outpatient unbilled accounts report for outstanding and/or uncoded outpatient encounters to reduce accounts receivable days for outpatients. Brings identified issues to department managers for resolution.
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.
- RHIA, RHIT or CCS required
- Three years minimum hospital outpatient coding/edit experience
- Advanced personal computing skills including MS Outlook, MS Word, MS Excel
- Advanced technical skills required to learn and navigate a variety of software systems, trouble-shoot computer problems, install periodic updates to software programs and work efficiently in a virtual environment
- Strong written and verbal communication skills
- Ability to think/work independently, yet interact positively with team
- Advanced problem-solving skills and ability to quickly analyze a situation.
- Comprehensive knowledge of ICD-10 and CPT coding systems.
- Strong knowledge base of changes in LCDs and NCDs.
- Strong knowledge base of current NCCI and OCE guidelines
- Attention to detail is crucial to this position.
- Other functions as deemed necessary to complete and final bill claims accurately
- Previous auditing experience or strong training background in coding and reimbursement
- Outstanding interpersonal communication skills as well as excellent oral and written communication skills
- Comprehensive knowledge of the APC structure and regulatory requirements.
- Knowledge of medical terminology, anatomy and physiology, disease process, and surgical procedures
- RHIA, RHIT or CCS required