Not hiring out of CA, DC, MN, CO, HI, NJ, CT, IL, NV, DE, MA, or NY.
Job Summary: The Clinical Coding Analyst is responsible for pre-bill inpatient chart reviews specific to MS DRG assignment. The analyst is responsible for identifying revenue opportunities and compliance risks based on the Official ICD-10-CM/PCS Guidelines for Coding and Reporting, AHA Coding Clinics, disease process, procedure recognition, and clinical knowledge.
You’ll be a great fit for this role if you have:
- AHIMA credential of CCS, CDIP or ACDIS credential of CCDS is required. AHIMA Approved ICD-10 CM/PCS Trainer preferred.
- Graduate of an accredited Health Information Technology or Administration program with AHIMA credential of RHIT or RHIA preferred.
- Minimum of 7 years of acute inpatient hospital coding, auditing and/or CDI experience in a large tertiary hospital required.
- Experience with CDI (Clinical Documentation Improvement) programs preferred.
- Extensive knowledge of ICD-10 CM/PCS required.
- Experience with electronic health records (i.e., Cerner, Meditech, Epic, etc.) required.
- Experience working remotely required.
- Excellent oral and written communication skills required.
- Must demonstrate analytical ability, initiative, and resourcefulness.
- Ability to work independently required.
- Excellent planning and organizational skills required.
- Teamwork and flexibility required.
- Must be proficient in Microsoft Office Word and Excel programs.
Essential Job Duties and Responsibilities:
- Clinical Coding Analysts are assigned to a specific client(s) and have the primary responsibility of daily pre-bill chart reviews and communication to the client(s) within a 24-hour time frame for each chart reviewed.
- Provides daily client volumes to Audit Manager no later than 7am EST.
- Reviews the electronic health record to identify both revenue opportunities and potential coding compliance issues-based ICD-10-CM/PCS coding rules, AHA Coding Clinics, and clinical knowledge.
- Provide verbal review on all cases with a potential MS DRG recommendation and/or physician query opportunities with the Company Physician(s) via telephone call prior to submitting recommendations to the client.
- Ensures that the daily work list is uploaded into the MS DRG Database for assigned client(s) and enter required data elements for each patient recommendation into MS DRG Database.
- Prepares and composes all recommendations, including increased reimbursement, decreased reimbursement, and “FYI” for each account and communicates that to the client within 24 hours of receiving and reviewing the electronic medical record.
- Follows internal protocol on all client questions and rebuttals on cases reviewed within 24 hours of receipt.
- Responsible for review and appeal, if warranted, on Medicare and/or third-party denials on charts processed through the MS DRG Assurance program.
- Responsible for reviewing inclusions and exclusions specific to 30 Day Readmissions and Mortality quality measures on specific cohorts for traditional Medicare payers for specific clients.
- Maintains IT access at all client sites that have been assigned by ensuring that log on and passwords have not expired.
- Maintain current knowledge of ICD-10-CM/PCS code changes, AHA Coding Clinic, and Medicare regulations.
- Utilizes internal resources, such as TruCode, I10 Wiki, and CDocT.
- Adhere to all company policies and procedures.
Schedule: You choose your specific work hours, however, all CCAs are required to report daily client volumes to the Audit Manager by 7am EST for appropriate assignment. Our company typically runs 8am-5pm EST/CST. You will schedule daily meetings with the Physician team and will choose which times those meetings will occur. The Physician team is available between 7:30am-6pm EST, so ideally your work schedule will align within this timeframe.
Home Office Requirements:
- Must have a High-speed internet connection and a dedicated secure workspace to ensure adherence to HIPAA Privacy and Security policies and procedures when viewing protected health information (PHI).
- The Company will provide a laptop and access to necessary resources to perform job duties.
Interview Process:
- Case Study Skills Assessment (PCS Coding and Clinical Validation)
- Audit Manager/Team Lead Meeting – Video Call (1 hour)
- Verbal Case Study Discussion – Video Call (1 hour)
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