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Coding Reviewer (Remote)

Job ID: 10169
Location: Vancouver, WA
Work Type: Full Time
Shift: Day
Shift Length: 8 Hours
FTE: 1.00
Benefit Eligibility: Full-time benefits

Job Description

Description

PeaceHealth is seeking a Coding Reviewer - Coding and Charge Capture for a Full Time, Day position.  

JOB SUMMARY

The coding reviewer acts as an expert resource for auditing and training in support of accuracy and appropriateness of coding using ICD-10 and CPT industry standards and PeaceHealth guidelines.

ESSENTIAL FUNCTIONS

  1. Performs coding audits and pre-billing coding compliance functions as required by system regulatory policies/procedures and established review metrics. Participates in development of action plans to include follow up education on identified issues with subsequent audit and reassessment. Utilizes a vendor-based pre-billing compliance tool to review targeted records for coding accuracy, mortality, PSI and HAC review. Also performs post-billing medical record review focused on DRG validation.
  2. Develops training materials and curriculum for coding, external vendor, and CDI caregiver’s education.
  3. Serves as an expert resource for ICD-10/CPT as it affects coding, compliance and reimbursement. Assists with re-training efforts as a result of coding errors found. Delivers training and standards as directed.
  4. Reviews records for payor, RAC, regulatory denials/appeals, and downgrades by providing in depth coding review, audit findings and appeal strategies to the System Coding Leadership.
  5. Works in tandem with HIM Coding team to identify aberrant coding patterns and trends.
  6. May participate in integrated testing of Epic, 3M, or other external vendor software.
  7. May provide production coding support as required.
  8. Performs other duties as assigned.

QUALIFICATIONS

EDUCATION:

  • Graduate of formal coding program or combination of education and experience that provides the caregiver with the requisite knowledge, skills and abilities to perform the job required.
  • Completion of a college based or AHIMA approved coding education program is strongly preferred.

EXPERIENCE/TRAINING:

  • Minimum of three years acute care coding and/or auditing experience required.
  • Knowledge including ICD-10, MS-DRG/APR-DRG methodology, HCPCS/CPT coding, regulatory policies from CMS and other third-party regulations. Hands-on ICD-10 and/or CPT proficiency required.
  • Previous training experience preferred.

LICENSE/CERTIFICATION:

  • AHIMA/AAPC recognized credential is required: RHIA, RHIT, CCS, CPC, or CPC-H.

OTHER SKILLS:

  • Excellent verbal and written communication skills including sensitivity to other cultures and ethnicities.
  • Strong analytical skills..
  • Must possess excellent ability for conceptual thinking, good listening, problem resolution and planning skills.
  • Must possess excellent organizational skills.
  • Must demonstrate computer skills in Microsoft Office
  • Ability to work well independently and in a remote environment.

SYSTEM PHSYICAL/COGNITIVE REQUIREMENTS:

  • Work requires fairly light physical exertion from up to 65% of the time.
  • Ability to lift objects weighing 30 lbs. or less.
  • Work is performed under normal working conditions with adequate lighting and ventilation.
  • Job duties frequently require intense concentration and attention to detail (up to 65% of work time).

See how PeaceHealth is committed to Inclusivity, Respect for Diversity and Cultural Humility.

For full consideration of your skills and abilities, please attach a current resume with your application.  EEO Affirmative Action Employer/Vets/Disabled in accordance with applicable local, state or federal laws.  

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