PeaceHealth is seeking a Coding Reviewer - Coding and Charge Capture for a Full Time, Day position.
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.
- 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.
- Develops training materials and curriculum for coding, external vendor, and CDI caregiver’s education.
- 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.
- 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.
- Works in tandem with HIM Coding team to identify aberrant coding patterns and trends.
- May participate in integrated testing of Epic, 3M, or other external vendor software.
- May provide production coding support as required.
- Performs other duties as assigned.
- 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.
- 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.
- AHIMA/AAPC recognized credential is required: RHIA, RHIT, CCS, CPC, or CPC-H.
- 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.