Performs medical record audits to ensure accurate
assessment of external or internal ICD-10-CM code selection and appropriate
documentation to support. The objective
is to improve specificity and accuracy of diagnoses coding to show the true
clinical condition of patients.
ESSENTIAL JOB FUNCTIONS:
Perform code abstraction and/or
coding quality audits of medical records to ensure ICD-10-CM codes are
accurately assigned and supported by clinical documentation.
and/or performs electronic medical chart reviews.
Review and assign accurate medical
codes for diagnoses performed by physicians and other qualified healthcare
providers in the office or facility setting (e.g., inpatient hospital).
Verifies accuracy, completeness, and
appropriateness of diagnosis codes based on basic to moderately complex medical
Identify and communicate
documentation deficiencies to providers to improve documentation for accurate
risk adjustment coding.
Uses data analysis and language
software to identify opportunities and review for acceptance or rejection to
modify a claim based on documentation and ICD 10-CM correct coding
Identifies and documents coding
observations or discrepancies and provides information to management team to
further enhance quality and/or provider education.
Performs medical record audits on
external vendors risk adjustment work to ensure compliance with CMS and ICD 10
Select correct ICD code assignment
by proficient analysis and translation of diagnostic statements, physicians'
orders, and other pertinent documentation.
10. Critically evaluate valid encounters, including
face-to-face, legibility and valid signature, per Medicare, Commercial and
Federal and State requirements.
11. Assist coding leadership by making recommendations for
process improvements to further enhance coding quality goals and outcomes.
12. Understand the anatomy, pathophysiology, and medical terminology
necessary to correctly code Facilitate and obtain appropriate physician
documentation for any clinical conditions or procedures to support the
appropriate severity of illness diagnoses.
13. Performs other duties
a positive, professional, service-oriented work environment by supporting the
IHA CARES mission and core values statement.
able to work effectively as a member of the Compliance team.
completes IHA's "The Customer" training and adheres to IHA's standard
of promptly providing a high level of service and respect to internal or
knowledge of and complies with IHA standards, policies and procedures,
including IHA's Employee Handbook.
general knowledge of IHA office services and in the use of all relevant office
equipment, computer, and manual systems.
Serves as a role model, by demonstrating exceptional ability and willingness to take on new and
additional responsibilities. Embraces
new ideas and respect cultural differences.
Uses resources efficiently.
Performance that meets or exceeds IHA CARES
Values expectation as outlined in IHA Performance Review document, relative to
EDUCATION: Bachelor's Degree or equivalent combination
of education and experience.
CREDENTIALS/LICENSURE: Certified Professional Coder or RHIT certification is
required; Certified Risk Adjustment Coder (CRCtm) certification
EXPERIENCE: At least 2 years' experience required
abstracting risk adjusted codes from acceptable medical record documentation in
either a hospital or physician setting.
(ABILITIES & SKILLS):
1. Maintain current
knowledge of ICD-10-CM codes, CMS documentation requirements, and state and
2. Maintains working knowledge of federal, state, and
insurance company regulations and contract requirements affecting compliance in
a healthcare setting; compliance plan and auditing standards.
3. Substantial knowledge of managed care and insurance
practices, insurance claims and billing process, fee schedules and
4. Thoroughly comprehend
medical coding guidelines and regulations including compliance and
reimbursement and the impact of diagnosis coding on risk adjustment payment
5. Maintains currency in
all coding and reimbursement methods researching literature and attends
professional seminars, workshops, and conferences as required by the AHIMA
and/or AAPC to maintain professional certification.
6. Maintain and grow the
current knowledge of the Medicare and Commercial Risk Adjustment
outpatient/inpatient billing systems/processes.
7. Stay current on all
changes in coding conventions and coding updates.
8. Adhere to the coding
9. Work both in a team
and individual environment and is confident working with a wide variety of
10. Ability to meet
productivity and accuracy standards
11. Ability to defend
coding decisions to both internal and external audits.
12. Demonstrated understanding and/or hands-on experience with
office processes, procedures and workflows.
13. Proficiency in
multi-tasking and meeting sensitive deadlines in a fast-paced environment with
a personal commitment to producing the highest quality work and providing
extraordinary customer service; demonstrated ability to effectively follow
through on assigned projects.
14. Proficient in operating a standard desktop and Windows-based computer
system, including but not limited to, Microsoft Word and Excel, intranet and
computer navigation. Ability to use
other software as required while performing the essential functions of the job
including EPM and EHR systems.
communication skills in both written and verbal forms, including proper phone
16. Ability to work collaboratively in a team-oriented environment;
courteous, professional and friendly demeanor.
17. Ability to work effectively with various levels of organizational
18. Good organizational and time management skills to effectively juggle
multiple priorities and time constraints in a fast-paced environment.
19. Ability to exercise sound judgment and problem-solving skills.
20. Ability to maintain any organizational information in a confidential
21. Successful completion of IHA competency-based program within
introductory and training period.
22. Ability to work
overtime hours as scheduled.