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Coding Integrity Specialist

Location: Ithaca
Posted on: August 6, 2022

Job Description:

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 completeness.
  • 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 assignment.
    • Researches the AHA's coding clinic and official coding guidelines and other reference material to respond to disputes.
    • 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 procedures documented.
    • 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 (if necessary).
    • 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 and charging.
    • Works closely with the Clinical Documentation team to review discrepancies in DRG assignments and to provide education.
    • Maintains coding credential(s) and required continuing education credits.
    • Maintains confidentiality of all patient information.
    • Excellent written and verbal communication skills.
    • Other duties as needed to meet the needs of the organization/department

      Education Two year degree in Health Information Management required, Bachelors preferred. RHIT or RHIA credential required.
      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

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