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St. Luke's University Health Network
Coding Appeals Specialist
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What they do
A Clinical Documentation Specialist works with information technology systems and applications in health care organizations. Assists clinicians and staff with technology and implementing new systems. Creates systems for organizing and interpreting data and information for clinical trials. Records and manages clinical information about patients, including health assessments and diagnoses, test results, treatments, and follow up care requirements. Reviews and maintains patient records.
$61,571 / year median in the U.S.
-3% projected decline
Job Description
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locations
Allentown, PA
- 1110 American Parkway time type Part time posted on Posted 5 Days Ago job requisition id R136970 St.
AHA ICD-9-CM/ICD-10-CM/PCS
diagnoses and/or procedures support the services/treatment rendered.JOB DUTIES AND RESPONSIBILITIES
Conduct retrospective medical record reviews for diagnosis and procedure code assignment and MS-DRG accuracy. Identify and provide feedback, including identification of trends, to the Network Coding and CDMP Managers for education of the medical staff, clinical documentation professionals and the coding professionals on documentation issues that affect proper documentation and coding of documented medical care for appropriate reimbursement. Work with the physician liaison in review of patient medical records identified by RAC/MIC/CGI/QIO and other outside auditors in retrospective reviews for DRG and coding-related issues. May participate in review of other medical necessity issues as needed. Develop and apply appeal arguments to defend the coding of and by the coding professionals and be able to refute the coding determination made by the outside payor including but not limited to CMS, Aetna, IBC, Omniclaim, QIP, Gateway Health, etc. Draft appeal letters, including the coding argument, to support network coding. Identify clinical documentation improvement issues and through excellent communication with physicians, nurses, coding and other members of the health care team and work independently to resolve such issues. Participate as needed in Administrative Law Judge (ALJ) hearings. Spends approximately 20% of their time weekly coding/abstracting patient medical records according to ICD-10-CM/PCS, UHDDS and CMS guidelines. Utilizes the 3M Encoder to verify and assignICD-10-CM/PCS
diagnosis and procedure codes, and MS-DRG assignment. Performs data entry of coded patient medical records into EPIC, maintaining a 95% coding accuracy rate as measured through quality reviews. Queries physicians when code assignments are not clear and consistent, or when documentation in the record is inadequate, ambiguous, or unclear for coding assignment.PHYSICAL/SENSORY DEMANDS
Sitting, standing and light lifting. Repetitive arm/finger use retrieving/viewing computerized patient medical record and abstracting of patient information. Corrected vision and hearing to within normal range. Hearing as it relates to normal conversation. Works inside with adequate lighting, comfortable temperature and ventilation.EDUCATION
RHIA, RHIT and/or CCS with knowledge of ICD-9-CM andICD-10-CM/PCS
diagnosis/procedure coding and MS-DRG assignment. Minimum of 5 years coding experience in an acute care, teaching hospital, inpatient setting required.TRAINING, KNOWLEDGE AND EXPERIENCE
Minimum 5 years demonstrated inpatient and/or outpatient coding experience in acute care, teaching setting. Knowledge of anatomy and physiology, pathophysiology, and medical terminology required. Working knowledge of ICD-10-CM/PCS and ability to understand complex disease processes strongly preferred. Possesses extensive knowledge of reimbursement systems; extensive knowledge of federal, state, and payer-specific regulations and policies pertaining to documentation, coding and, as needed, medical necessity. Previous experience with electronic patient medical record/EPIC and 3M encoding system preferred. Please complete your application using your full legal name and current home address. Be sure to include employment history for the past seven (7) years, including your present employer. Additionally, you are encouraged to upload a current resume, including all work history, education, and/or certifications and licenses, if applicable. It is highly recommended that you create a profile at the conclusion of submitting your first application. Thank you for your interest in St. Luke's!! St. Luke's University Health Network is an Equal Opportunity Employer. Similar Jobs (5) Inpatient Coding Specialist (Remote- Full Time | PA & NJ Candidates) locations Allentown, PA
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