New Hanover Regional Medical Center Coding Reimbursement Spec - Coding - HIM in Wilmington, North Carolina
Coding Reimbursement Spec - Coding - HIM
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Coding - HIM
This position has access to and knowledge of extremely sensitive, private and confidential materials. Ability to maintain the highest standard is required with zero tolerance. All the primary duties within this document will be performed according to established policies, procedures and guidelines within the department and the Medical Center. JOB SUMMARY: The Coding Reimbursement Specialist- RAC works independently but reports to the Coding and Clinical Abstracting Manager. This specialist is responsible for monitoring the appropriateness of the code assignments, including HIM assigned and chargemaster assigned codes, and reporting these findings to the Manager. Serves as a contact for coding denials, responding to record requests, writing appeals, and following up as necessary. The specialist will make appropriate corrections to claims to resolve CCI and Medical Necessity edits to ensure appropriate charges and diagnosis are present on the final bill. This person will analyze the data from coding and/or charging errors and denials, and will follow-up and process appeals within time limits. This specialist will, under the direction of the Manager, hold education sessions with coding staff, physicians, documentation specialists, billing staff, and ancillary department charge entry staff as needed to prevent future denials. This person will maintain extensive knowledge of IPPS and OPPS reimbursement, including ICD-9-CM and ICD-10, CPT HCPCS codes, UB-04 revenue codes, modifiers, billing regulations and coding guidelines. He/She will remain current on all coding updates and changes, as well as payer specific requirements and regulations. This specialist will also serves as a resource for information or clarification on CCI edits, LCDs/ NCDs, ethical coding, documentation standards, and regulatory requirements. PRIMARY JOB DUTIES: 1. Identifies revenue cycle issues related to coding denials, researches/analyzes data to recommend solutions. 2. Serves as a contact for coding denials, responding to record requests, writing appeals, and following up as necessary. 3. Promptly processes all assigned denials and appeals according to appropriate coding guidelines, billing rules, payor guidelines and regulations, within time limits. 4. Performs trend analyses to identify patterns and variations in coding/charging practices works with appropriate staff to correct issues. 5. Communicates trends in departmental charging/coding issues to the Coding Manager and/or designee. 6. Makes appropriate corrections to claims to resolve CCI and OP Medical Necessity edits to ensure appropriate charges and diagnosis are present on the final bill. 7. Serves as a resource to obtain necessary clarifications or concerns regarding DRG Assignment, CPT/HCPCS, UB-04 revenue coding, modifiers, billing regulations and coding guidelines CCI edits, LCDs/ NCDs, and ethical coding and documentation standards. 8. Maintains productivity and quality at or above standards with minimal supervision. Manages time effectively to permit completion of workload. 9. Analyzes payer regulations, including DRG/APC assignment, CCI edits, LCDs and NCDs, and the impact on reimbursement and coding guidelines. 10. Holds education sessions, under the direction of the manager, with coding staff, physicians, documentation specialists, billing staff, and ancillary department charge entry staff as needed to prevent denials. 11. Promotes public relations through prompt and courteous service. 12. Completes continuing education as required to maintain competency and credentials (if applicable) as well as to stay current with coding rules and guidelines. 13. Performs other duties necessary to ensure all accounts are processed accurately and efficiently. 14. Codes all diagnosis, treatments, and procedures according to the appropriate classification system for that category of patient encounter, and in accordance with provisions of the Uniform Hospital Discharge Data Set as well as the interpretation of these provisions as issued by the American Hospital Association and American Health Information Management. 15. Abstracts patient information from records of all designated patient accounts as well as other designated patient types, and enters appropriate data elements into the computerized abstracting system. 16. Demonstrates standards of performance (ownership, teamwork, communication, compassion) that support patient satisfaction and principles of service excellence. 17. Performs other duties as assigned. ESSENTIAL JOB SPECIFICATIONS: 1. Education: B.S., B.A., or A.A in Health Information Management or related health field required. 2. Licensure / Certifications: RHIT, RHIA, RN, LPN, CPC, CCS or CCS-P required, Must meet continuing education requirements annually for credential and/or certification 3. Experience: Three years relevant healthcare coding/ revenue cycle experience required. Extensive knowledge of ICD-9-CM, ICD-10 CM/PCS, CPT/HCPCS, UB-04 revenue coding, modifiers, billing regulations and coding guidelines, CCI edits, LCDs/ NCDs, and ethical coding and documentation standards required. Five years experience in healthcare coding, claims auditing and denial processing, hospital based preferred. Combination of relevant education and/or experience considered.