About the Job:
Clinical Coding Analyst (Remote)
The Clinical Coding Analyst is a specialized role focusing on pre-bill inpatient chart reviews for MS DRG assignment. The position entails thorough analysis and identification of revenue enhancement opportunities and potential compliance risks by adhering to official ICD-10-CM/PCS guidelines, AHA Coding Clinics, and leveraging disease and procedure recognition expertise alongside clinical knowledge. This role is key to ensuring accurate and compliant medical coding practices that directly impact the financial and operational efficiency of healthcare providers.
Compensation: DOE
Essential Duties and Responsibilities:
- Clinical Coding Analysts are assigned specific clients and are primarily responsible for daily pre-bill chart reviews.
- Communicate findings to the client(s) within a 24-hour timeframe for each chart reviewed.
- Provide daily client volumes to the Audit Manager no later than 7am EST.
- Review electronic health records to identify both revenue opportunities and potential coding compliance issues based on ICD-10-CM/PCS rules.
- Engage in verbal consultations with Company Physicians to discuss potential MS DRG modifications or physician query opportunities before finalizing recommendations.
- Ensure that the daily work list is uploaded into the MS DRG Database, entering required data elements for each patient recommendation.
- Compose and deliver recommendations regarding increased or decreased reimbursement and comply with client communications within 24 hours of initial review.
- Follow internal protocol to address client questions and rebuttals on cases reviewed within 24 hours of receipt.
- Handle reviews and, if necessary, appeals on Medicare and/or third-party denials for the MS DRG Assurance program.
- Review specific patient cohorts for traditional Medicare payers concerning 30 Day Readmissions and Mortality quality measures.
- Maintain current knowledge of coding updates, AHA Coding Clinic advisories, and Medicare regulations.
Minimum Position Qualifications:
- AHIMA credential of CCS, CDIP or ACDIS credential of CCDS required.
- Graduate of an accredited Health Information Technology or Administration program with AHIMA credentials of RHIT or RHIA preferred.
- Minimum of 7 years of acute inpatient hospital coding, auditing, and/or CDI experience in a large tertiary hospital.
- Extensive knowledge of ICD-10 CM/PCS.
- Experience with multiple electronic health record systems such as Cerner, Meditech, Epic, etc.
- Demonstrable experience working remotely.
Preferred Qualifications:
- AHIMA Approved ICD-10 CM/PCS Trainer certification.
- Experience with Clinical Documentation Improvement (CDI) programs.
- Proven ability to independently manage workload and meet deadlines.
- Strong analytical skills and proficiency in Microsoft Office, especially Word and Excel.
- Excellent oral and written communication skills.
Skills:
- Proficient in usage of MS DRG Database and various coding software and tools.
- Skilled in data entry and database management.
- Ability to maintain high levels of confidentiality and data security standards.
- Excellent planning and organizational skills.
- Team-oriented with a capability to work flexibly and under pressure.
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