Address
Form of workOverview:
Health Information Management Outpatient Coder Specialist
Covenant Health Overview:
Position Summary:
Recruiter: Kathleen Rice || kkarnes@covhlth.com || 865-374-5386
Responsibilities:
Minimum Experience:
Licensure Requirement:
Health Information Management Outpatient Coder Specialist
Full Time, 80 Hours Per Pay Period, Day Shift
Covenant Health Overview:
Covenant Health is East Tennessee’s top-performing healthcare network with 10 hospitals and over 85 outpatient and specialty services, and Covenant Medical Group, our area’s fastest-growing physician practice division. Headquartered in Knoxville, Covenant Health is a community-owned, not-for-profit healthcare system and the area’s largest employer with over 11,000 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 || kkarnes@covhlth.com || 865-374-5386
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, pre-cert, 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.
- 13 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.
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.
