Coding Integrity Specialist

Company Overview:

Cayuga Health is the region's leading healthcare system, and most trusted driver of integrated health services, together with valued partners. We empower our people and employ our capabilities to equitably improve the well-being of the communities we serve. At Cayuga Health System, our commitment to providing extraordinary health care begins with our team. Our extraordinary professionals are continuously discovering clinical innovations and enhanced access to the most up-to-date facilities, equipment, technologies, and research protocols. We have a commitment to its employees by providing competitive rates and compensation, a comprehensive employee benefits programs, attractive working conditions, and the chance to build and explore a career opportunity by offering professional development.

Nestled in the beautiful Finger Lakes region, Cayuga Health provides an outstanding place to work in a vibrant community. Come discover all that Ithaca, New York and Cayuga Health has to offer!

Position Overview:The Coding Integrity Specialist performs independent reviews of hospital medical records including inpatient, emergency department, outpatient and observation to ensure appropriateness of coding and charges. Reviews disputes and denials received from third party payers and review agents, Insurance Payers, IPRO, Livanta, etc. Works closely with the Coding Manager and Coding Team Supervisor to prepare education and training material based on coding guidelines, new technology, denials, medical practice and new trends discovered during chart audits.

Minimum Qualifications:

• Audits inpatient and outpatient medical record documentation for coding: DRG, APC and APG assignment accuracy and completeness.
• Reviews of denials and third-party payers disputes (IPRO, Insurance (Including Medicare/Medicaid), Livanta, etc.) by performing the following:
  • Reviews medical record documentation for completeness and accuracy, coding guidelines, DRG assignment, SOI and ROM assignment.
  • Researches the AHA's coding clinic and official coding guidelines and other reference material to respond to disputes.
  • Reviews the sequencing of diagnoses and procedures following UHDDS guidelines and CMS regulations.
  • Collaborates with the attending physician of the medical director's office as needed for support of the diagnoses and procedures documented.
  • Responds within our denial management software to the CHS denials team to appeal.
• Works with Coding Team to develop and deliver education for coding staff, including ICD10-CM and PCS annual updates
• Works closely with the Revenue Cycle team to validate coding and charging.
• Works closely with the Clinical Documentation team to review discrepancies in DRG assignments and to provide education.
• Maintains coding credential(s) and required continuing education credits.
• Maintains confidentiality of all patient information.
• Excellent written and verbal communication skills.
• Other duties as needed to meet the needs of the organization/department

Requirements:

Education - Two year degree in Health Information Management required, Bachelors preferred. RHIT or RHIA credential required.

Experience - Five or more years of combined experience in coding and auditing. Two or more years of supervisory/auditing experience preferred. Working knowledge of ICD10 CM/PCS and CPT coding classification. Knowledge of DRG's, APC's and APG's.

Licensure - Certification with AAPC or AHIMA, AHIMA preferred (RHIT, RHIA, CCS, etc).

Physical Requirements - The position requires a high degree of mental and visual concentration. No lifting requirements. Requires long period of sitting, with repetitive motion.

At this time Cayuga Health System will not sponsor a new applicant for employment authorization for this position.

If you are interested in applying for this position and you require an accommodation, please contact Cayuga Health System at hr@cayugamed.org

Cayuga Health System Commitment to Diversity, Equity & Inclusion

Cayuga Health System commits to treating all people with dignity so that everyone who comes to us is safe, cared for, and respected. We will support the growth of our employees and the health of our community by embracing the rich diversity of social and cultural identities, needs, and life circumstances of all people. We strive to recognize and overcome personal biases and systemic policies that marginalize others and contribute to disparities in healthcare access, equitable care, and good health outcomes.

Cayuga Health is dedicated to our vision for diversity, equity, and inclusion. As we strive towards our vision, we welcome the opportunity to work alongside a diverse range of employees.