Virtual HIM Outpatient Coding Auditor I

Interested in a career with both meaning and growth? Whether your abilities are in direct patient care or one of the many other areas of healthcare administration and support, everyone at Parkland works together to fulfill our mission: the health and well-being of individuals and communities entrusted to our care. By joining Parkland, you become part of a diverse healthcare legacy that's served our community for more than 125 years. Put your skills to work with us, seek opportunities to learn and join a talented team where patient care is more than a job. It's our passion.

PRIMARY PURPOSE

Conducts audits of medical record coding to ensure compliance with established guidelines, provides results of audits, and assists with educational activities related to findings to promote adherence to state/federal laws and regulatory requirements.

MINIMUM SPECIFICATIONS

Education:

- Must be a graduate of a Health Information Management program or must have successfully completed an approved Coding educational program.

Experience:

- Must be a Registered Health Information Administrator (RHIA) plus four years of review/coding experience; OR must be a Registered Health Information Technician (RHIT) plus six years of review/coding experience; OR must be a Certified Coding Specialist (CCS), Certified Coding Specialist-Physician (CCS-P), Certified Professional Coder (CPC),or Certified Professional Coder-Hospital (CPC-H) with eight years of review coding experience.

Equivalent Education and/or Experience

- May have an equivalent combination of education and experience to substitute for the experience requirements.

Certification/Registration/Licensure

- Must be a Registered Health Information Administrator (RHIA), or Registered Health Information Technician (RHIT), or Certified Coding Specialist (CCS), or Certified Coding Specialist-Physician (CCS-P), or Certified Professional Coder (CPC),or Certified Professional Coder-Hospital (CPC-H).

Skills or Special Abilities

- Must be able to demonstrate time management, organizational, oral and written communication skills.

- Must be proficient and demonstrate and advanced knowledge in ICD-9-CM and CPT/HCPCS coding and abstracting and have an advanced clinical knowledge of medical terminology, disease process and pharmacology.

- Must score a minimum of 85% on a pre-employment coding test.

- Must be able to demonstrate knowledge of reimbursement (Medicare and Medicaid) principles and methodologies (MS-DRG and APC).

- Must have a working knowledge of the compliance guidelines related to coding and billing.

- Must have strong skills in diplomacy, professionalism and trustworthiness.

- Must be able to demonstrate excellent computer skills, including word processing, spreadsheet and database management software proficiency.

Responsibilities

1. Conducts quality reviews on all coders using the official coding guidelines as published in AHA Coding Clinic and AMA CPT Assistant, and hospital policy, including specific payer guidelines, rules, regulations in analyzing questionable documentation to ensure the accuracy and completeness of clinical and financial information reported for billing of hospital services. Provides feedback to the coders on findings as needed. Provides reports of findings to the Coding Compliance Manager. The Outpatient area utilizes the CMS regulatory coding and billing guidelines, the National Correct Coding Initiative, the Local and National Coverage Determinations to resolve billing edits.

2. Analyzes medical record documentation to assure that coding and abstracting of data is in compliance with the official coding guidelines as published in the American Hospital Association's Coding Clinic for ICD-9-CM and the American Medical Associations CPT Assistant

3. Maintains knowledge of applicable rules, regulations, policies, laws and guidelines that impact the coding area. Provides input as requested to assist in the development of effective internal controls that promote adherence to applicable state/federal laws, and the program requirements of accreditation agencies and federal, state, and private health plans.

4. Stays abreast of the latest developments, advancements, and trends in medical records coding by attending educational programs, reading professional journals, actively participating in professional organizations, and maintaining certification. Integrates knowledge gained into current work practices.

5. Assists in ensuring that abstracted coded data and other elements are correct and appropriate. Assists in ensuring that data being submitted to state/federal and other regulatory agencies is correct and appropriate.

6. Maintains a positive working relationship with physicians, nurses, medical staff and hospital employees to ensure that all work-related encounters are productive.

7. Identifies ways to improve work processes and improve customer satisfaction. Makes recommendations to supervisor, implements, and monitors results as appropriate in support of the overall goals for the department and Parkland.

8. This position is 100% Virtual. Virtual employees must also comply with all Parkland policies and procedures governing the use of Parkland information resources. Virtual employees must maintain all equipment lent by Parkland for performing the agreed upon job duties in good working condition. All employment responsibilities and conditions in applicable Parkland policies and procedures apply to employees while working virtually.

#LI-SS2

Parkland Health and Hospital System prohibits discrimination based on age (40 or over), race, color, religion, sex (including pregnancy), sexual orientation, gender identity, gender expression, genetic information, disability, national origin, marital status, political belief, or veteran status.As part of our commitment to our patients and employees' wellness, Parkland Health is a tobacco and smoke-free campus.