Coding Spec-Clinic
Coding Spec-Clinic
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1 Vacancy
Job Description
Overview
Coding Specialist Centralized Coding
Full Time 80 Hours Per Pay Period Day Shift
Covenant Health Overview:
Covenant Health is East Tennessees topperforming healthcare network with 10hospitals and over 85outpatient and specialtyservicesandCovenant Medical Group our areas fastestgrowing physician practice division. Headquartered in Knoxville Covenant Health is a communityowned notforprofit healthcare system and the areas largest employer with over 11000 employees.
Covenant Health is the only healthcare system in East Tennessee to be named six times by Forbes as a Best Employer.
Position Summary:
This individual provides leadership direction and training for the coding staff. Working directly with the physicians Manager of Corporate Coding Services Director of Registration/Admitting and medical staff education efforts serves as the user advocate between Health Information Management (HIM) Clinical Effectiveness and Registration. Other job duties include: improving health record documentation and coding accuracy developing and updating all departmental policies and procedures relative to coding performing quality reviews of coding/abstracting and focusing on problem solving issues related to denials. Provides assurance that billing practices are complete accurate and in compliance with state and federal guidelines.
Recruiter: Kathleen Rice
Responsibilities
- Oversees through monitoring and by reviewing and auditing the coding staff to ensure position accountabilities and performance criteria are adhered to.
- Develops and maintains departmental and hospital policies and procedures and implements new policies and procedures relative to coding.
- Educates and assists physicians and clarifies coding versus clinical issues.
- Works closely with Registration and Business Office personnel to resolve issues related to claims coding precert and denials appeals and verifies that appropriate chargemaster rates are used.
- Reviews medical record documentation to ensure existing documentation supports diagnostic/procedure code billed per UB 92 or HCFA 1500 form.
- Provides education to coding staff and physicians in response to regulatory changes and identified areas of deficiency.
- Monitors claim rejections and systematically assesses specific types of denial as it relates to coding and documentation issues outpatient registration and the receipt of physician orders.
- Attends meetings and provides input as it relates to coding medical documentation and reimbursement issues specific to medical billing and regulatory requirements.
- Increases awareness of compliance as it relates to coding and documentation.
- Facilitates and coordinates education of coding staff in the areas of coding documentation case mix and denials.
- Increases understanding of APCs DRGs case mix and denials.
- Educates coding staff to proper documentation necessary to support a DRG/APC/Medical Necessity/ROM/SOI.
- Integrates documentation coding and proper oversight to ensure accurate reimbursement.
- Reviews records to verify if the correct code has been assigned.
- Assists with all insurance requested audits and provides information to supervisor related to inaccurate and/or missing documentation.
- Reviews DRG/APC classifications and educates to maximize level of care assignment for increased reimbursement.
- Keeps current on local state and federal regulations to ensure compliance.
- Keeps current on coding guidelines and communicates to Health Information Manager. Implements corrective actions as indicated to minimize financial risk.
- Works with Denials Elimination Group and deals with physician specific issues as it impacts denials.
- Ensures LCDs/NCDs are being adhered to by admissions and hospital personnel to ensure qualifying diagnosis covers tests/procedures.
- Analyzes denials and coordinates appeals.
- Ensures corrective action is taken to prevent denials from reoccurring.
- Follows policies procedures and safety standards. Completes required education assignments annually. Works toward achieving goals and objectives and participates in quality improvement initiatives as requested.
- Performs other duties as assigned.
Qualifications
Minimum Education:
None specified; however must be sufficient to meet the standards for achievement of the below indicated license and/or certification as required by the issuing authority.
Minimum Experience:
Five or more 5 years coding experience.
Licensure Requirement:
RHIA Coding or RHIT certification required. Registered Health Information Technologist preferred.
Employment Type
Full-Time
