Medical Coder Auditor- HIM Coding & CDI Quality

Job Description

Description

Become part of an inclusive organization with over 40,000 diverse employees, whose mission is to improve the health and well-being of the unique communities we serve.

Position is mostly remote but does require training new staff onsite occasionally.

Summary:
This position trains and audits medical coders, either inpatient or outpatient across all HCS entities that are owned or managed that have opted into shared services. This position reports to the HCS Supervisor Coding and CDI Quality and Training. This position provides mentoring and training of new coding staff and ongoing training for existing staff. The position audits and provides feedback as needed and attends IP and OP huddles to respond to coder questions and provide training and education. This position processes and appeals insurance coding denials. This position analyzes coded records for compliance with federal, state and third party insurer rules and regulations and note trends. This position educates physicians and staff on error trends and how to prevent/reduce errors to maximize reimbursement, accurately reflect expected mortality, and demonstrate compliance.

Responsibilities:
1. Audits inpatient and outpatient medical coders to assure a minimum of 95% accuracy and recommends education and training related to results.
2. Assigns and/or audits IP and OP Coders assignment of International Classification of Diseases 10-CM (ICD-10) diagnostic and ICD-10-PCS procedural codes, Current Procedural Terminology (CPT) codes with modifiers, and other applicable codes in an accurate and productive manner on inpatient, outpatient (observation, ambulatory surgery, and ancillary cases).
3. Faxes, tracks, and monitors coding denials and appeals. Reviews coding insurance denials and refers clinical coding denials to the CDI Physician Advisors.
4. Resolves insurance denials that have been accepted by updating the coding and send for rebilling if required.
5. Generate coding appeals for insurance denials with sound arguments and based on coding guidelines and conventions.
6. Generates coding appeals as a result of CDI Physician Advisor reviews suggesting appeal. Coordinates Peer to Peer requests with third party payers and CDI Physician Advisors and prepares for meeting.
7. Researches and resolves problems referred by coders and provides prompt feedback.
8. Provides input on performance of coders and audit information to supervisor for performance evaluations.
9. Provides information to physicians and other health care staff regarding current coding practices and changes in 3rd party, state and federal regulations and guidelines.
10. Provides training and serves as a general resource to assist other coders and members of department staff.
11. Provides training to Physicians, non-physician providers and their support staff on coding guidelines and conventions.
12. Participates in and provides education sessions as needed on specific coding topics at huddle meetings and other forums.
13. Reviews, analyzes and abstracts physician/other documentation for diagnoses, procedures, ancillary testing, medications, laboratory and other services provided.
14. Communicates with physicians and other health care staff to obtain missing information or to clarify existing information.
15. Reviews edits generated from PWC SMART software, resolves, and educates coding staff.
16. Utilizes a variety of software (e.g. Optum, Epic, PWC SMART, MS Office, etc.) to compile and validate medical information.

Other Information

Other information:
Education Requirements:
● Associate degree in Health Information Management or related field or an equivalent combination of education, training, and experience.
● Successful completion of the UNC HCS IP or OP Coder Proficiency Test as applicable.
Licensure/Certification Requirements:
● Must have one of the following: - AHIMA (American Health Information Management Association) certification and credential - AAPC (American Academy of Professional Coders) certification and credential
Professional Experience Requirements:
● If Associate’s degree: Five (5) years of experience in medical coding or acute care.
● If High School Diploma: Nine (9) years of experience in medical coding or acute care.
Knowledge/Skills/and Abilities Requirements:
● Strong knowledge of ICD-10/PCS/CPT/HCPCS coding and billing compliance (MS-DRGs/IPPS, APC/OPPS) with excellent analytical and data mining skills. Ability to effectively participate and supervise projects, plan and implement programs, and evaluate outcomes. Ability to effectively work directly with various levels of staff (including on-site and remote) as well as manage vendor relationships and expectations. Must possess strong communication skills, both written and verbal. Exhibits effective organizational skills, time management, and management of multiple priorities. Ability to make effective and persuasive presentations on complex topics to management and physicians. Ability to teach and mentor coders and physicians on complex coding systems. Ability to have an excellent balance of being highly productive and yet produce high quality work. Must be able to create strong argument based on solid coding guidelines in generating appeals. Ability to interpret federal and state regulations as they relate to coding and compliance.

Job Details

Legal Employer: NCHEALTH

Entity: Shared Services

Organization Unit: HIM Coding & CDI Quality

Work Type: Full Time

Standard Hours Per Week: 40.00

Work Schedule: Day Job

Location of Job: US:NC:Chapel Hill

Exempt From Overtime: Exempt: No

This position is employed by NC Health (Rex Healthcare, Inc., d/b/a NC Health), a private, fully-owned subsidiary of UNC Health Care System, in a department that provides shared services to operations across UNC Health Care; except that, if you are currently a UNCHCS State employee already working in a designated shared services department, you may remain a UNCHCS State employee if selected for this job.

Qualified applicants will be considered without regard to their race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

UNC Health makes reasonable accommodations for applicants' and employees' religious practices and beliefs, as well as applicants and employees with disabilities. All interested applicants are invited to apply for career opportunities. Please email [email protected] if you need a reasonable accommodation to search and/or to apply for a career opportunity.