Description

Summary: Assist the Director of HIM in preparing claim audits, reviewing and recommending coding, revenue cycle and charge/billing changes on client hospital outpatient and Profee claims using proprietary software product. Use software to develop standardized reports, meet with clients, respond to coding questions in clear, concise, grammatically correct English, and provide support for other members of the revenue cycle consulting team. Client education, written FAQ answer preparation, and other duties as assigned.

Requirements

QUALIFICATIONS

•        5+ years of directly related experience
•        Expert knowledge in revenue cycle and Outpatient coding (ER, SDS, OBS, ancillary, IR, Profee, E/M facility, I&I)
•        Medical Terminology and anatomy knowledge is required
•        Clinical Documentation and Inpatient coding experience is preferred.  New hires will be expected to learn IP during employment. 
•        Must have strong understanding of revenue cycle, CMS Manual/guidelines, Medicaid guidelines.
•        Strong Microsoft Excel, PowerPoint, Word and OneNote skills
•        Must have strong understanding of the Official Coding Guidelines, OP coding and billing (i.e. including but not limited to knowledge of rev codes, HCPCS, MUE and CCI edits, UoS)
•        Strong analytical capability, independent thinker and good decision-making skills
•        Excellent written and verbal communication and presentation skills
•        Strong computer and technology knowledge and skills
•        Highly professional demeanor, great client satisfaction skills

ESSENTIAL DUTIES AND RESPONSIBILITIES

•        Become proficient in the use of the PARA Data Editor, our proprietary software;
•        Select and review claims for review based on trends/data analysis in the PARA Data Editor; organize information and access to medical documentation. 
•        Audit all aspects of claim including (but not limited to):
  • Omitted or incorrect charges,
  • Review OPPS and CAH charges and apply guidelines.
  • CMS/Payer specific guidelines
  • Coding accuracy for ICD-10 CM, PCS (if applicable), CPT/HCPCS (including but not limited to 10000-69999, 80000, 90000, J codes, G codes, Q codes, etc)
  • Departmental review for inaccuracies, omitted data/documentation and charges
  • NCCI edits, MUE edits, Medi-cal and Medicare guidelines/CMS Manual guidance,
  • Units of services
  • E/M Profee/Facility
  • Units of services
  • Documentation improvement.
  • Assist in preparing written documents for publication under the direction of the Director, HIM, i.e., Q&A entries.
  • Develop a working understanding of the outpatient hospital reimbursement process, including documentation, coding, and billing.
  • Participate in presentations to clients and prospective clients, typically over web meetings.
  • Develop and maintain the skills and knowledge necessary related to the assigned specialty areas and the related services. Keep current on all related information from journals and bulletins. Distribute and pass on all necessary materials, including copying for reference files when relevant.
  • Maintain current certifications and accreditations (as applicable).
  • Research new guidelines, data elements, payer specifications, etc. 
  • Other duties may be assigned as necessary.