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Clinical Monitoring and Coding Specialist Job in Farmington, Connecticut

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Job Title: Clinical Monitoring and Coding Specialist

Employer:UConn Health
Type:FULL TIME, OTHER
Location: Farmington 06030, CT, US
Date Posted:9/2/2021

JOB TITLE:              Clinical Monitoring and Coding Specialist

 

 

Purpose of Class:

At 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.

 

SUPERVISION RECEIVED:

Works under general supervision of employee of higher grade.

 

SUPERVISION EXERCISED:

May lead staff as assigned.

 

EXAMPLES OF DUTIES:

Participates 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.

Develops 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 practices.

Summarizes monitoring findings and provides feedback and education to clinical operations and management.

Recommends corrective actions/solutions when monitoring efforts identify areas of non-compliance and follows up on recommendations to evaluate and report on status of recommended corrective actions/solutions.

 

Maintains 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.

 

Serves 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.

 

Evaluates 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.

 

Provides guidance on policies and procedures relating to documentation and coding processes necessary for coding and billing compliance.

 

Evaluates 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 investigation outcomes.

Identifies 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.

Performs other related duties as required or directed.

 

MINIMUM 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

·      Experience 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 service orientation

·      Teaching ability

EXPERIENCE AND TRAINING:

Ten 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

 

PREFERRED QUALIFICATIONS:

Experience working in an Academic Medical Center

Certification in Healthcare Compliance

 

 

Interested applicants should apply at:

https://jobs.uchc.edu/CSS_External/CSSPage_JobDetail.ASP?T=20210722135749&

The 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

employer.

Applying

Interested applicants should apply at:

https://jobs.uchc.edu/CSS_External/CSSPage_JobDetail.ASP?T=20210722135749&


The search number for this position is 2022-008.


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