Coding Integrity Specialist
Company: CARDINAL SERVICES LTD.
Posted on: August 6, 2022
The Coding Integrity Specialist performs independent reviews of
hospital medical records including inpatient, emergency department,
outpatient and observation to ensure appropriateness of coding and
charges. Responds to disputes and denials received from third party
payers and review agents, IPRO, Livanta, etc. Works closely with
the HIM Coding Manager and Coding Team Leader to prepare education
and training material based on coding guidelines, new technology
and medical practice and new trends discovered during chart audits.
The specialist will be responsible for resolving edits identified
from the systems scrubber timely, to ensure accounts are released
to billing timely.
Job Responsibilities include:
- Audits inpatient and outpatient medical record documentation
for coding: DRG, APC and APG assignment accuracy and
- Responds to denials and third-party payers dispute (IPRO,
Medicare, Livanta, etc.) by performing the following:
- Reviews medical record documentation for completeness and
accuracy, coding guidelines, DRG assignment, SOI and ROM
- Researches the AHA's coding clinic and official coding
guidelines and other reference material to respond to
- Reviews the sequencing of diagnoses and procedures following
UHDDS guidelines and CMS regulations.
- Collaborates with the attending physician of the medical
director's office as needed for support of the diagnoses and
- Prepares letters of response to RAC, IPRO and/or other
third-party agencies defending/explaining coding as well as DRG,
APC and APG assignment.
- Prepares reports of audit finding to HIM Leadership and Quality
- Prepares cases for appeal.
- Works with Coding Team to develop and deliver education for
coding staff, including ICD10-CM and PCS annual updates
- Works closely with the Revenue Cycle team to validate coding
- Works closely with the Clinical Documentation team to review
discrepancies in DRG assignments and to provide education.
- Maintains coding credential(s) and required continuing
- Maintains confidentiality of all patient information.
- Excellent written and verbal communication skills.
- Other duties as needed to meet the needs of the
Education Two year degree in Health Information Management
required, Bachelors preferred. RHIT or RHIA credential
Experience Five or more years of combined experience in coding and
auditing. Two or more years of supervisory/auditing experience
preferred. Working knowledge of ICD10 CM/PCS and CPT coding
classification. Knowledge of DRG's, APC's and APG's.
Licensure Certification with AHIMA (RHIT, RHIA, CCS, etc)
Physical Requirements The position requires a high degree of mental
and visual concentration. No lifting requirements. Requires long
period of sitting, with repetitive motion.
Keywords: CARDINAL SERVICES LTD., Syracuse , Coding Integrity Specialist, Other , Ithaca, New York
Didn't find what you're looking for? Search again!