Essential Functions
Assists
in oversight of the department for review activity and deadlines, training of
staff, input for employee evaluations, and ensures department audit goals are
met. Also generates
and reviews pivot tables for procedures.
Conducts chart
reviews of medical records for outpatient/inpatient providers. Reports on
documentation to support CPT and ICD10 codes and RAF reviews. Provides timely
provider communication by memo and telephone. Identifies deficiencies and
educational needs of provider. Reports clear and detailed recommendations to
improve documentation of level of service billed specificity of ICD10 codes and
RAF scores. Determines the level of inservice education needed for providers. Communicates
credible and concise findings in provider reports. Presents in a professional,
organized and positive manner.
Demonstrates a
contribution to the department’s operation and goals/targets for the year.
Maintains monthly log of activity, Completes 10 charts/quarter for assigned
providers. Conducts reviews within the department production rate determined on
an annual basis. Prioritizes workload maintains control over interruptions.
Demonstrates
ability to use auditing software program, IDX system, LCD and local hospital
resources to conduct reviews and summary of findings. Ability to use the TES
program in IDX for retrospective or concurrent reviews. Pursues medical records
needed from outside resources (i.e. SNF, other hospitals)
Identifies
departmental process discrepancies during review process. Compiles monthly
documentation of keying errors by provider, DOS, MRN and batch number. Reports
any operational areas of risks identified. Recommends improvements to encounter
forms. Reports treatment inconsistencies for review.
Identifies
departmental process discrepancies during review process. Compiles monthly
documentation of keying errors by provider, DOS, MRN and batch number. Reports
any operational areas of risks identified. Recommends improvements to encounter
forms. Reports treatment inconsistencies for review.
Adheres to
guidelines set by the clinic’s Compliance Program and Audit policy and
procedures
Required
Education and Experience: High School diploma or equivalent and a minimum of 5 years
coding/healthcare reimbursement experience. Certification by American
Academy of Professional Coders (CPC) for a minimum of 5 years or equivalent
organization and CRC (Certified Risk Coder). CRC certification must be obtained
within 3 months. Must have advanced knowledge in medical terminology and anatomy.
Must have advanced knowledge of insurance reimbursement, principles and
practice. Must have knowledge of computer and Microsoft Office.