Schedule Weekly Hours:
40This is a 1.0 FTE = 80 hours every 2 weeks. This position will be working remote, however candidates must be within a reasonable driving distance to be able to come in for occasional meetings and training. We can only accept candidates from WI, IA and MN.Job Description:The Coding Integrity Specialist works under direction of the Manager of Clinical Documentation Improvement to ensure accurate and compliant coding of hospital and clinic services through coding review, continued education, and feedback to coding leadership and staff along with the continual development and maintenance of an effective quality audit review program. This could include but is not limited to reviews of E&M, in-office procedures, ancillary services, Emergency Services, Urgent Care, and professional hospital services, including guidelines specific to prospective payment system, Rural Health Clinic, and Critical Access Hospital. This individual will work independently on most assignments but will collaborate with Coding Services Managers, Supervisors and Leads for planning and implementation.
Major Responsibilities:
1. Implements the department’s internal quality control and assurance program. Performs internal audits to ensure staff compliance with coding and reimbursement guidelines. Provide input to a coding supervisor’s assessment of a coder’s adherence to ICD-10 CM and/or PCS coding conventions (International Classification of Diseases, 10th revision, Clinical Modification and/or Procedure Coding System), the CPT rules (Current Procedural Terminology) established by the AMA (American Medical Association), the AAPC code of ethics and/or the AHIMA Standards of Ethical Coding and risk adjustment models, ie. hierarchical condition category (HCC) coding.
2. Coordinates and project manage internal and external audits.
3. Monitor coding specialist’s compliance with provider query policies to acquire documentation which supports appropriate procedure and diagnosis codes. Assess the adequacy of documentation to support code assignment. Escalate documentation issues according to departmental policy.
4. Identifies, based on audit assessments, opportunities for continued education and coordinates with managers, supervisors and leads to facilitate.
5. Identifies, based on assessments, potential opportunities for improved clinician documentation and alignment of the application of coding guidelines.
6. Demonstrate in depth knowledge and technical expertise in code sets including CPT, HCPCS, ICD-10 as well as the current national, regional, and local payer policies for coding, billing, and claims processing. Partner with leaders in Revenue Cycle and Clinical Documentation Improvement to monitor, research, translate, interpret, and communicate new developments and changes that will impact provider documentation and coding. Serves as an informational resource for coding staff and Revenue Cycle leadership.
7. Collaborate with coding Supervisors to identify, assess, obtain, and deploy tools to support employees in their daily work such as reference material, staff development resources, and technology. Assist the Manager to review, evaluate and recommend software applications that will enhance the efficiency and accuracy of code assignment.
8. Manage multiple assignments and requests simultaneously and appropriately prioritize ad hoc requests.
9. Adheres to regular and predictable attendance.
10. Perform other job-related responsibilities as requested.
Education and Learning:
REQUIRED
Associate degree in Health Information Management or a related field or a high school diploma or equivalency and a coding certification (see license and certification requirements).
DESIRED
Bachelor's degree in Health Information Management or a related field
Work Experience:
REQUIRED
5-7 years of experience in healthcare coding of multi-specialty clinics, hospital inpatient or outpatient setting
DESIRED
Experience as coding auditor. 7+ years of experience in healthcare coding of multi-specialty clinics, hospital inpatient or outpatient setting
License and Certifications:
REQUIRED
Registered Health Information Administrator (RHIA) or Registered Health Information Technician (RHIT) or Certified Coding Specialist (CCS) or Certified Coding Specialist – Physician based (CCS-P) or Certified Professional Coder (CPC) or Certified Coding Associate (CCA)
DESIRED
Certified Professional Medical Auditor (CPMA)
Age Specific Population:
N/A
Osha Category:
Category 3 - Employees in this job title have no reasonably anticipated risk of occupational exposure to blood and/or other potentially infectious materials.
Environmental Conditions:
Not substantially exposed to adverse environmental conditions (as in typical office work)
Physical Requirements/Demands of The Position:
Sitting Continually (67-100% or 8 hours)
If you need assistance with any portion of the application or have questions about the position, please contact HR-Recruitment@gundersenhealth.org or call 608-775-0267
Equal Opportunity Employer