About the Job:
Clinical Coding Analyst (Remote)
The Clinical Coding Analyst is essential in ensuring the accuracy and integrity of medical coding for inpatient services, which directly impacts revenue and compliance for healthcare institutions. The role involves conducting thorough pre-bill inpatient chart reviews, focusing on MS DRG assignments to identify revenue opportunities and mitigate compliance risks. Utilizing comprehensive clinical knowledge and coding guidelines, the analyst plays a critical role in maintaining high standards within the coding process, making accurate recommendations, and supporting healthcare providers with insightful analysis to optimize patient documentation and healthcare delivery.
Compensation: DOE
Essential Duties and Responsibilities:
- Perform daily pre-bill chart reviews ensuring accurate MS DRG assignment and communicating findings to clients within a 24-hour timeframe.
- Report daily client volumes to Audit Manager by 7am EST for assignment distribution and workload management.
- Discuss all cases with potential MS DRG changes or physician query opportunities with the company Physician via phone before final recommendations.
- Maintain and manage updates in the MS DRG Database, entering required data for each patient reviewed.
- Compose and communicate chart review recommendations to clients, including potential for increased or decreased reimbursement.
- Address client inquiries and rebuttals regarding reviewed cases within 24 hours, ensuring ongoing client satisfaction and accuracy.
- Handle Medicare and third-party denials by reviewing and appealing cases as necessary to optimize reimbursement.
- Review specific patient cohorts for compliance with 30 Day Readmissions and Mortality quality measures specific to traditional Medicare payers.
- Ensure continuous access to client systems by managing IT credentials and ensuring compliance with security protocols.
- Stay updated with ICD-10-CM/PCS code changes, AHA Coding Clinic updates, and Medicare regulations to ensure compliance and accuracy.
Minimum Position Qualifications:
- AHIMA credential of CCS, CDIP or ACDIS credential of CCDS is required.
- Minimum of 7 years of acute inpatient hospital coding, auditing, or CDI experience in a large tertiary hospital.
- Extensive knowledge of ICD-10 CM/PCS, with experience working with electronic health records such as Cerner, Meditech, Epic.
- Proven experience in a remote work environment is essential.
- Strong analytical ability with excellent oral and written communication skills.
- Ability to work independently with outstanding planning and organizational abilities.
Preferred Qualifications:
- 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.
- Experience with Clinical Documentation Improvement (CDI) programs preferred.
- Demonstrated initiative and resourcefulness in past coding and auditing roles.
- Ability to maintain flexibility and teamwork in a dynamic, changing environment.
Skills:
- Proficient in Microsoft Office Word and Excel.
- Strong ability to analyze and interpret medical records and coding guidelines.
- Excellent time management skills to meet daily deadlines and handle varying workloads.
- Effective communication skills to liaise with physicians, client representatives, and team members.
- Meticulous attention to detail necessary for accurate coding and compliance.
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