Coding Quality Analyst

Job Summary
Knowledge of CPT, HCPCS, CMS claim formats (1450 and HCFA 1500)
Understanding of general billing and reimbursement guidelines or healthcare background
Effectively manages time and resources.
Processing pended claims and provider appeals, which consists of reviewing medical records and using various coding resources to confirm correct coding.
Beginning with Microsoft (Word, Excel, Visio, OneNote, etc.)
Essential Functions

• Meets with providers and coding employees regularly on billing, coding and reimbursement issues applicable to their specialty.
• Reviews monthly reporting from billing system with a focus on revenue cycle metrics, unbilled accounts, and adequate documentation.
• Acts as a liaison between the Coding department and Spectrum Health to enhance educational awareness of coding and documentation. Participates and initiates process and quality improvement activities.
• Reviews coding patterns/trends and provides ongoing consultation to providers regarding coding and documentation issues.
• Proactively identifies and communicates problems and opportunities; actively recommends and implements solutions or process improvements.
• Presents information to physicians, administrators and other institutional leadership.
• Acts as an expert resource for administrators and physicians in regulatory, coding, billing compliance and financial functions.

Qualifications

• Required Bachelor's Degree accounting, finance, health care administration, or related field or equivalent combination of education and experience

• 2 years of relevant experience progressive experience in various hospital functions (e.g., professional/facility coding, reimbursement, billing, and/or chargemaster maintenance) Required

• CRT-Registered Health Information Administrator (RHIA) - AHIMA American Health Information Management Association Upon Hire required Or
• CRT-Registered Health Information Technician (RHIT) - AAPC American Academy of Professional Coders Upon Hire required Or
• CRT-Coding Specialist (CCS) - AHIMA American Health Information Management Association Upon Hire required Or
• CRT-Professional Coder - AAPC American Academy of Professional Coders Upon Hire required

Physical Demands

• Pallet to Waist (6" from floor) > 5 lbs: Seldom up to 10 lbs
• Waist to Waist > 5 lbs: Seldom up to 10 lbs
• Waist to Chest (below shoulder) > 5 lbs: Seldom up to 10 lbs
• Waist to Overhead > 5 lbs: Seldom up to 10 lbs
• Bilateral Carry > 5 lbs: Seldom up to 10 lbs
• Unilateral Carry > 5 lbs: Seldom up to 10 lbs
• Pushing Force > 5 lbs: Seldom up to 10 lbs
• Pulling Force > 5 lbs: Seldom up to 10 lbs
• Sitting: Frequently
• Standing: Occasionally
• Walking: Occasionally
• Forward Bend - Standing: Seldom
• Forward Bend - Sitting: Occasionally
• Trunk Rotation - Standing: Seldom
• Trunk Rotation - Sitting: Occasionally
• Reach - Above Shoulder: Seldom
• Reach - at Shoulder or Below: Seldom
• Handling: Occasionally
• Forceful Grip > 5 lbs: Seldom
• Forceful Pinch > 2 lbs: Seldom
• Finger/Hand Dexterity: Frequently

Primary Location
SITE - Priority Health - 1239 E Beltline - Grand Rapids
Department Name
PH - Medical Code Review
Employment Type
Full time
Shift
Day (United States of America)
Weekly Scheduled Hours
40
Hours of Work
8 a.m. to 5 p.m.
Days Worked
Monday to Friday
Weekend Frequency
N/A
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Corewell Health is committed to providing a safe environment for our team members, patients, visitors, and community. We require a drug-free workplace and require team members to comply with the MMR, Varicella, Tdap, and Influenza vaccine requirement if in an on-site or hybrid workplace category. We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process, to perform the essential functions of a job, or to enjoy equal benefits and privileges of employment due to a disability, pregnancy, or sincerely held religious belief.
Corewell Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, gender, pregnancy, sexual orientation, gender identity or expression, veteran status, or any other legally protected category.
An interconnected, collaborative culture where all are encouraged to bring their whole selves to work, is vital to the health of our organization. As a health system, we advocate for equity as we care for our patients, our communities, and each other. From workshops that develop cultural intelligence, to our inclusion resource groups for people to find community and empowerment at work, we are dedicated to ongoing resources that advance our values of diversity, equity, and inclusion in all that we do. We invite those that share in our commitment to join our team.
You may request assistance in completing the application process by calling 616.486.7447.