PURPOSE OF POSITION:

Responsible for ongoing analysis of clinical and billing documentation and related issues to assess the appropriateness of coding levels, patient medical record documentation coverage determinations and reimbursement levels.

PRIMARY DUTIES AND RESPONSIBILITIES:

• Responsible for identifying, and assessing risk areas in regards to billing compliance and working with clinical, financial and operational managers to make improvements in those areas.
• Assist with coordination of timely responses to governmental and third-party audits.
• Coordinates responses to external requests for clinical documentation in the context of audit activities.
• Obtains itemized bills, remittance advices and medical records and conducts internal audits based on applicable laws, documentation guidelines and coverage determinations.
• Conducts audits that compare medical record documentation to billed services.
• Prepares written reports of findings and recommendations designed to improve clinical documentation practices related to billing practices, coding determinations, and operational efficiencies.
• Presents audit findings to appropriate committees, department heads and physicians.
• Prepares management and departmental reports.
• Assess patterns in coding/billing that may result in incorrect billing of services.
• Assist with preparation and processing of appeals to governmental agencies.
• Maintains a current working knowledge of all coding and reimbursement rules, regulations, resources, trends and new developments.
• Participate in miscellaneous internal audits and other projects as assigned.

EDUCATION/EXPERIENCE/TRAINING   

• Bachelor's degree preferred.
• Registered Health Information Administrator (RHIA) or Registered Health Information Technician and Certified Coding Specialist (CCS) required
• Minimum of 3 years of previous experience in Medical Record coding for reimbursement with strong working knowledge of reimbursement groupers such as DRGs and APCs as well as third party reimbursement requirements.
• Certified Coder with 3-5 years documented clinical audit experience.
• Knowledge of Medicare and other insurance coding and documentation requirements.
• Must be able to interact effectively and professionally with representatives of governmental agencies, third party payers and internal clinical and operation personnel.
• Must be able to prioritize and handle multiple work assignments
• Excellent communication skills, both oral and written, with emphasis on report writing.
• Computer skills - Strong Excel and Word knowledge.