As a part of the Tenet and Catholic Health Initiatives family, Conifer Health brings 30 years of healthcare industry expertise to clients in more than 135 local regions nationwide. We help our clients strengthen their financial and clinical performance, serve their communities and succeed at the business of healthcare. Conifer Health helps organizations transition from volume to value-based care, enhance the consumer and patient healthcare experience and improve quality, cost and access to healthcare. Are you ready to be part of our solutions? Welcome to the company that gives you the resources and incentives to redefine healthcare services, with a competitive benefits package and leadership to take your career to the next step!
The Spec, CRC Coding Audit is responsible for retrospective auditing of denied claims related to DRG reimbursement. Under general virtual supervision, the Revenue Cycle Coder:
Regularly exercises discretion and independent judgement when completing medical record quality audits of clinical documentation including application of appropriate rules and regulations related to ICD-9 CM diagnosis, principal DX coding, MSDRG assignment, CPT, HCPCS or any other coding classification system to ensure proper reimbursement.
Completing medical record audit and documenting clinical rationale supporting: 1) modification to tertiary DRG; 2) written clinical appeal based on supporting medical record documentation utilizing industry accepted coding guidelines/clinics; and/or 3) not appealable determination.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Include the following. Others may be assigned.
Performs retrospective (post â��discharge/ post-service) medical record quality audits to determine appellate potential of claims with denied reimbursement related to Inpatient and Outpatient coding data.
Constructs and documents a succinct and fact based case to support appeal utilizing appropriate resources and medical record document to support the appeal. (Resources include: AHA Official Coding and Reporting Guidelines, CMS guidelines, ICD-9-CM and CPT coding.)
Demonstrates ability to critically think, problem solve and make independent decisions supporting coding appellate process.
Demonstrates proficiency in ability to achieve accuracy and consistency in the selection of principal and secondary diagnoses (including MCC and CC) and procedures. Provides education/feedback and coding guidance to client regarding coding cases that did not warrant appeal resolution.
Demonstrates proficiency in utilization of electronic tools utilized during the medical record quality review process including but not limited to application of coding guidelines; patient accounting application; worklisting application; visual imaging/scanning application; payor websites, electronic medical record, etc.
Demonstrates basic patient accounting knowledge i.e. UB04 and EOB components, adjustments, credits, debits, balance due, patient liability, etc.
a) Serves as a resource to non-coding personnel.
b) Provides CRC leadership with sound solutions related to process improvement
Assist in development of policy and procedures as business needs dictate.
d) Responds to requests from clients, including legal counsel related to completed medical record reviews
Responsible for submitting telecommuting expenses timely.
KNOWLEDGE, SKILLS, ABILITIES
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Demonstrates quality proficiency by maintaining 97.5% accuracy.
Possesses excellent written, verbal and communication skills
Possesses professional letter writing skills
Critical thinker, able to make decisions regarding coding standards independently
Ability to interact intelligently and professionally with other clinical and non-clinical clients
Ability to multi-task and manage competing priorities effectively
Demonstrates computer literacy including typing skills and solid knowledge base of Microsoft Office suite including Word, Excel, PowerPoint and Outlook, coding and abstracting software/hardware
Ability to work independently in a remote environment
Ability to conduct research regarding State/Federal guidelines and applicable regulatory processes related to Government Audit processes.
Maintains coding credentials and completes required continuing education
EDUCATION / EXPERIENCE
Include minimum education, technical training, and/or experience required to perform the job.
4 years of comprehensive healthcare coding and abstracting of government and non-government payers for inpatient and outpatient records preferred.
4 years comprehensive healthcare coding/documentation auditing experience or equivalent preferred.
4 yearsâ�� experience with encoders and computerized abstracting systems preferred
Required: Bachelors or Associates degree HIM discipline or equivalent.
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Ability to lift 15-30lbs
Ability to travel approximately 10% of the time; either to client sites, National Insurance Center (NIC) sites, Headquarters or other designated sites
Ability to sit and work at a computer for a prolonged period of time conducting medical record quality reviews
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Characteristic of typical office environment requiring use of desk, chair, and office equipment such as computer, telephone, printer, etc.
Interaction with facility HIM.
Must meet the requirements of the Conifer Telecommuting Policy and Procedure
Job: Conifer Health Solutions
Primary Location: Frisco, Texas
Job Type: Full-time
Shift Type: Days
Employment practices will not be influenced or affected by an applicantâ��s or employeeâ��s race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship.
Internal Number: 2105012834
About Conifer Health Solutions
Tenet Healthcare Corporation (NYSE: THC) is a diversified healthcare services company headquartered in Dallas with 112,000 employees. Through an expansive care network that includes United Surgical Partners International, we operate 65 hospitals and approximately 510 other healthcare facilities, including surgical hospitals, ambulatory surgery centers, urgent care and imaging centers and other care sites and clinics. We also operate Conifer Health Solutions, which provides revenue cycle management and value-based care services to hospitals, health systems, physician practices, employers and other clients. Across the Tenet enterprise, we are united by our mission to deliver quality, compassionate care in the communities we serve.