|Skills:||Four (4) years of experience utilizing ICD-10 and/or ICD-10-CM,ICD-10-PCS,AHA Coding Clinic and CDI essential resources as well as respective reimbursement methodologies associated with each coding system required
|Specialties:||In patient hospital coding experience
|Required Certifications:||LPN and/or CCS,RHIT,RN,RHIA
|Required Experience:||3 to 4 years
|Preferred Experience:||5 to 7 years
The Clinical & Coding Specialist-Senior will be responsible for the higher-level claims analytical review, preparation, implementation, summarization and communication of clinical and contractual audits as it pertains to all industry standard coding systems, (ICD-9-CM, ICD-10, CPT, HCPCs,). The Clinical & Coding Specialist-Senior will have demonstrated project management skills and have the ability to lead cross-function teams to assure goals are accomplished using standard project management organization tools and processes. The Clinical & Coding Specialist-Senior will support the Manager, Hospital Audit in accomplishing the audit business plan for all aspects of the audit plan.
- Associates degree required. Minimum of one of the following certifications: Registered Health Information Management Administrator (RHIA), Registered Health Information Technician (RHIT), NYS licensed RN, American Health Information Management Association (CCS-H, CCS-P), Academy of Professional Coders (CPC) required.
- Four (4) years of experience utilizing ICD-9-CM, ICD-10, CPT, HCPCS coding systems as well as respective reimbursement methodologies associated with each coding system required.
- Demonstrated experience reviewing health care delivery against clinical, quality, as well as financial established guidelines.
- Demonstrated analytical & critical thinking skills. Ability to ensure that clinical/claims data reporting is in compliance with requested data set. Ability to prepare quantitative and qualitative studies at conclusion of audit. Ability to recalculate reimbursement following conclusion of audit in accordance with corporate provider contracts and/or IHA policy & procedures.
- Autonomous/Independent worker, minimal supervision, including process management skills. Demonstrated subject matter expert in all coding systems.
- Demonstrated project management skills and proficiency with project management software.
- Demonstrated ability to serve as effective team member of cross-functional teams and/or proven ability to facilitate teams.
- Demonstrated understanding of organizational business strategies as well as audit and reimbursement related business strategies.
- Demonstrated organizational skills, verbal & written communication skills with ability to effectively communicate with personnel and providers externally.
- Demonstrated PC/Windows skills with proficiency in Microsoft Word, Excel and Access.
- Ability to travel locally to hospitals and out of the area when necessary. Local travel required. Any Independent Health associate who uses a motor vehicle in the course of their duties representing Independent Health must be compliant with New York State Motor Vehicle laws and must follow the policy that pertains to Driver’s License Requirements as a condition of employment.
- Knowledge of facility contract reimbursement policies.
- Proven examples of displaying IH values: Passionate, Caring, Respectful, Trustworthy, Collaborative, and Accountable.
- Assumes role of project manager as it relates to the re-engineering of the hospital audit process.
- Responsible for the ongoing management of 1-2 Day Inpatient Medical Admission and Readmission audits to include trends of clinical findings and financial recoupment statistics.
- Responsible for all reconsideration clinical appeals to include: review of records, consultation with Medical Director, responses to facilities as well as coordination of all aspects of these functions for external review agent process (Dispute Resolution Agency).
- Serves as the subject matter expert for each audit to include internet research of industry standards (clinical/coding), that may be used to assist in the creation or revision of Independent Health policies, procedures and provider contracts.
- Prepares and presents audit results as needed, to various levels of internal senior leadership for approval of financial recoveries, provider education, and/or recommendation for next steps.
As an Equal Opportunity / Affirmative Action Employer, Independent Health and its affiliates will not discriminate in its employment practices due to an applicant’s race, color, creed, religion, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender identity or expression, transgender status, age, national origin, marital status, citizenship, physical and mental disability, criminal record, genetic information, predisposition or carrier status, status with respect to receiving public assistance, domestic violence victim status, a disabled, special, recently separated, active duty wartime, campaign badge, Armed Forces service medal veteran, or any other characteristics protected under applicable law.