JOB TITLE: Clinical Monitoring and Coding Specialist
Purpose of Class:
UConn Health, this class utilizes a combination of clinical and financial
expertise to identify, evaluate and monitor compliance risk areas within UConn Health’s
clinical operations. Monitoring responsibilities include:
performing medical chart reviews, analyzing complex data (medical and
financial) and assessing internal controls to evaluate compliance with federal
and state regulations, payer coverage guidelines and UConn Health’s policies
and procedures. Makes
recommendations based on monitoring findings to enhance compliant processes and
provides corrective action follow-up when required. Is a key participant in development
of the annual compliance monitoring plan.
under general supervision of employee of higher grade.
lead staff as assigned.
EXAMPLES OF DUTIES:
in development of the annual compliance monitoring plan to include: identifying
compliance risk areas, evaluating degrees of institutional risk, assessing
existing internal controls and implementing the monitoring plan.
monitoring templates and tools.
Generates data from the electronic
medical record system to support monitoring efforts.
Researches regulations, payer
contractual terms and/or UConn Health policies and procedures relevant to monitoring
plan focus areas.
Reviews clinical documentation,
provider coding and billing records and third party insurance payment records.
Evaluates medical chart
documentation to assist
UConn Health in enhancing compliance with: documentation of medical necessity,
accurate diagnosis and procedure coding and service-specific required
Summarizes monitoring findings and provides
feedback and education to clinical operations and management.
actions/solutions when monitoring efforts identify areas of non-compliance and follows up on
recommendations to evaluate and report on status of recommended corrective
a high level of technical knowledge and skills related to procedure and
diagnosis coding, documentation standards and billing requirements for both the
physician office and hospital outpatient settings. Familiarity and a working
knowledge of inpatient DRG coding is also preferred.
as a subject matter expert on the interpretation and application of
documentation and coding guidelines and regularly reviews documentation and
coding processes and makes recommendations for improvement.
the effectiveness of internal controls designed to ensure that processes and
practices lead to appropriate execution of regulatory requirements and
standards related to clinical documentation, coding, billing and reimbursement.
guidance on policies and procedures relating to documentation and coding
processes necessary for coding and billing compliance.
the effectiveness of existing and proposed systems and procedures to determine
efficiency, effectiveness, risk and compliance with regulatory requirements and
UConn Health policies and procedures.
Assists operational areas with the
development of monitoring plans and the implementation, monitoring and
enforcement of area-specific compliance initiatives.
Investigates alleged compliance incidents, develops
corrective action plans to resolve issues, and tracks, monitors and reports on
opportunities for enhanced compliance training and education and provides
ongoing training and education to appropriate departments and individuals.
As requested, participates in internal and/or external
audits or reviews.
other related duties as required or directed.
QUALIFICATIONS REQUIRED – KNOWLEDGE, SKILL & ABILITY
· Experience working
with electronic medical record and billing systems
· Knowledge of medical
record documentation standards and best practices.
· Extensive knowledge
of procedural and diagnosis coding in both the physician office and hospital
outpatient setting. Familiarity and a working knowledge of hospital inpatient
DRG coding highly desirable.
· Working knowledge
of Medicare and Medicaid coverage guidelines and reimbursement methodologies
developing monitoring templates and tools
· Strong analytical skills and attention to detail
· Effective interpersonal skills required to interface with
medical staff, other clinicians, residents, students, operational directors,
managers and administrative staff
· Proven organizational and planning skills as well as the
ability to handle multiple tasks simultaneously
· Excellent communication skills and a positive customer
· Teaching ability
years’ experience from a combination of the following:
· Experience working
as an RN or other clinical professional in a clinical setting performing direct
care activities – acute hospital and/or physician office experience preferred.
Minimum of 4 years required.
· Experience working
with program integrity activities (e.g., reviewing medical record documentation
for compliance with statutes and policies, reviewing medical claims for correct
coding or unusual billing patterns)
· Experience in
professional and/or hospital procedural and diagnosis coding with a coding
certification from an accredited program
working in an Academic Medical Center
in Healthcare Compliance
Interested applicants should apply at:
search number for this position is 2022-008.
UConn Health is an
affirmative action employer, in addition to an EEO and M/F/V/PWD/PV