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!

JOB SUMMARY

This position will be functioning under the Manager. This position will assist manager and supervisor in training new team members, coordinate queries from ancillary departments regarding DNFB and edit tasks. The Sr. Edit Coder will investigate and solve edit issues and communicate root cause data to management to solve problems upstream and downstream in a professional manner.

Responsible for modifying and completing moderate to high complexity coding and charging edits/errors using ICD-10-CM, CPT and HCPCS or any other designated coding classification system in accordance with coding rules and regulations. Abides by the Standards of Ethical Coding as set forth by AHIMA. Abstracting required clinical information from the medical record. Working in Bill Scrubber systems a requirement.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Include the following. Others may be assigned.

• Performs data quality reviews on outpatient encounters to validate the ICD-10-CM, CPT, and HCPCS Level II code and modifier assignments, APC group appropriateness, missed secondary diagnoses and/or procedures, and ensure
• compliance with all APC mandates and outpatient reporting requirements. Monitors medical visit code selection by departments against facility specific criteria for appropriateness. Assists in the development of such criteria as needed. Monitors facility CRC reports for prebill edits related to APC. Addresses CCI and LCD edits within the various billing scrubbers while abiding by the Standards of Ethical Coding as set forth by the American Health Information Management Association. Meets and/or exceeds Coniferâ��s APC specialist productivity standards.
• Runs reports, reviews data and identifies opportunities or trends. Can define DNFB and use data to drive results. Ability to dissect data and display and communicate data in meaningful manner. Ability to maneuver thru various electronic systems effectively.
• Ability to deal with customer/partner issues and resolve conflict. Ability to multi-task and meet deadlines. Will help editors with non-complex edit questions.
• Reviews claim denials in comparison with medical records for the determination of accurate assignment of all documented diagnoses and procedures adhering to the standards of ethical coding.
• Monitors inpatient and outpatient unbilled accounts report for outstanding and/or uncoded outpatient encounters to reduce accounts receivable days for outpatients. Brings identified issues to department managers for resolution.

Conifer requires its candidates, as applicable and as permitted by law, to obtain and provide confirmation of all required vaccinations and screenings prior to the start of employment. This may include, but is not limited to, the COVID-19 vaccination, influenza vaccination, and/or any future required vaccines and screenings.

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.

• RHIA, RHIT or CCS required
• Three years minimum hospital outpatient coding/edit experience
• Advanced personal computing skills including MS Outlook, MS Word, MS Excel
• Advanced technical skills required to learn and navigate a variety of software systems, trouble-shoot computer problems, install periodic updates to software programs and work efficiently in a virtual environment
• Strong written and verbal communication skills
• Ability to think/work independently, yet interact positively with team
• Advanced problem-solving skills and ability to quickly analyze a situation.
• Comprehensive knowledge of ICD-10 and CPT coding systems.
• Strong knowledge base of changes in LCDs and NCDs.
• Strong knowledge base of current NCCI and OCE guidelines
• Attention to detail is crucial to this position.
• Other functions as deemed necessary to complete and final bill claims accurately

EDUCATION / EXPERIENCE

Include minimum education, technical training, and/or experience required to perform the job.

• Previous auditing experience or strong training background in coding and reimbursement
• Outstanding interpersonal communication skills as well as excellent oral and written communication skills
• Comprehensive knowledge of the APC structure and regulatory requirements.
• Knowledge of medical terminology, anatomy and physiology, disease process, and surgical procedures

CERTIFICATES, LICENSES, REGISTRATIONS

• RHIA, RHIT or CCS required

PHYSICAL DEMANDS

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 15-20lbs
• Ability to sit and work at a computer for a prolonged period of time completing assessments and analysis
• Includes ability to walk through hospital-based departments across broad campus settings, including Emergency Department environments

WORK ENVIRONMENT

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.
• Work environment is at a moderate noise level.

OTHER

• Professional appearance and demeanor

Employment practices will not be influenced or affected by an applicant�s or employee�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.