As a part of the Tenetand Catholic Health Initiatives family, Conifer Health brings 30 years ofhealthcare industry expertise to clients in more than 135 local regionsnationwide. We help our clients strengthen their financial and clinical performance,serve their communities and succeed at the business of healthcare. ConiferHealth helps organizations transition from volume to value-based care, enhancethe consumer and patient healthcare experience and improve quality, cost andaccess to healthcare. Are you ready to be part of our solutions? Welcome to the company that gives you theresources and incentives to redefine healthcare services, with a competitivebenefits package and leadership to take your career to the next step!
Thisposition will be functioning under minimal supervision and utilizingindependent decision making. Thisposition is to problem solve and complete edits with consistency andefficiency. The Edit Coder will investigate and solve edit issues and communicateroot cause data to management to solve problems upstream and downstream.
Responsiblefor modifying and completing moderate to high complexity coding and chargingedits/errors using ICD-10-CM, CPT and HCPCS or any other designated codingclassification system in accordance with coding rules and regulations. Abidesby the Standards of Ethical Coding as set forth by AHIMA. Abstracting required clinical informationfrom the medical record. Working in BillScrubber systems a requirement.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Include the following. Others may be assigned.
Performsdata quality reviews on outpatient encounters to validate the ICD-10-CM, CPT,and HCPCS Level II code and modifier assignments, APC group appropriateness,missed secondary diagnoses and/or procedures, and ensure compliance with allAPC mandates and outpatient reporting requirements. Monitors medical visit codeselection by departments against facility specific criteria forappropriateness. Assists in the development of such criteria as needed.Monitors facility CRC reports for prebill edits related to APC. Addresses CCI and LCD edits within thevarious billing scrubbers while abiding by the Standards of Ethical Coding asset forth by the American Health Information Management Association. Meetsand/or exceeds Coniferâs APC specialist productivity standards.
Reviewsclaim denials in comparison with medical records for the determination ofaccurate assignment of all documented diagnoses and procedures adhering to thestandards of ethical coding.
ProfessionalDevelopment: Stays current with AHA Official Coding and Reporting Guidelines,CMS and other agency directives for ICD-10-CM/PCS, ICD-10 initiatives, andCPT/HCPCS coding. Stays current with CMS annually updated National CorrectCoding Initiative Coding Policy Manual, CMS coding and billing regulations, MUEand OCE.
Monitorsinpatient and outpatient unbilled accounts report for outstanding and/oruncoded outpatient encounters to reduce accounts receivable days foroutpatients. Brings identified issues to department managers forresolution.
KNOWLEDGE, SKILLS, ABILITIES
To perform this job successfully, an individualmust be able to perform each essential duty satisfactorily. The requirementslisted below are representative of the knowledge, skill and/or abilityrequired. Reasonable accommodations may be made to enable individuals withdisabilities to perform the essential functions.
Advancedpersonal computing skills including MS Outlook, MS Word, MS Excel
Advancedtechnical skills required to learn and navigate a variety of software systems,trouble-shoot computer problems, install periodic updates to software programsand work efficiently in a virtual environment
Strongwritten and verbal communication skills
Abilityto think/work independently, yet interact positively with team
Advancedproblem-solving skills and ability to quickly analyze a situation.
Attentionto detail is crucial to this position.
Otherfunctions as deemed necessary to complete and final bill claims accurately
EDUCATION / EXPERIENCE
Include minimum education, technical training,and/or experience required to perform the job.
Outstandinginterpersonal communication skills as well as excellent oral and writtencommunication skills
Knowledgeof medical terminology, anatomy and physiology, disease process, and surgical procedures
CERTIFICATES, LICENSES, REGISTRATIONS
RHIA,RHIT or CCS preferred but not required.
The physical demands described here arerepresentative of those that must be met by an employee to successfully performthe essential functions of this job. Reasonable accommodations may be made toenable individuals with disabilities to perform the essential functions.
Abilityto lift 15-20lbs
Abilityto sit and work at a computer for a prolonged period of time completingassessments and analysis
Includesability to walk through hospital-based departments across broad campussettings, including Emergency Department environments
The work environment characteristics describedhere are representative of those an employee encounters while performing theessential functions of this job. Reasonable accommodations may be made toenable individuals with disabilities to perform the essential functions.
Characteristicof typical office environment requiring use of desk, chair, and officeequipment such as computer, telephone, printer, etc.
Workenvironment is at a moderate noise level.
Professionalappearance and demeanor
Job: Conifer Health Solutions
Primary Location: Texas
Other Locations: Alabama,California,Florida,Georgia,Louisiana,Massachusetts,Missouri,Mississippi,North Carolina,Nebraska,Pennsylvania,South Carolina,Tennessee,New Jersey,Washington,Colorado,Montana,Michigan,Washington D.C.,Washington D.C.,District of Columbia,Washington D.C.,New York,Idaho,Kansas,Kentucky,Iowa,North Dakota,Minnesota,Arkansas,Oregon,South Dakota,Maryland,Arizona,Virginia,Indiana,Illinois,Ohio,Wisconsin,Rhode Island,Connecticut,New Hampshire,Vermont
Job Type: Full-time
Shift Type: Days
Employment practices will not be influenced or affected by an applicantâs or employeeâs race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship.