Medical Coder Auditor-HIM Coding & CDI Quality ID-2440

December 2, 2024

Summary:

This position trains and audits medical coders, either inpatient or outpatient across all HCS entities that are owned or managed that have opted into shared services. This position reports to the HCS Supervisor Coding and CDI Quality and Training. This position provides mentoring and training of new coding staff and ongoing training for existing staff. The position audits and provides feedback as needed and attends IP and OP huddles to respond to coder questions and provide training and education. This position processes and appeals insurance coding denials. This position analyzes coded records for compliance with federal, state and third party insurer rules and regulations and note trends. This position educates physicians and staff on error trends and how to prevent/reduce errors to maximize reimbursement, accurately reflect expected mortality, and demonstrate compliance.

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Responsibilities:

Audits inpatient and outpatient medical coders to assure a minimum of 95% accuracy and recommends education and training related to results.
Assigns and/or audits IP and OP Coders assignment of International Classification of Diseases 10-CM (ICD-10) diagnostic and ICD-10-PCS procedural codes, Current Procedural Terminology (CPT) codes with modifiers, and other applicable codes in an accurate and productive manner on inpatient, outpatient (observation, ambulatory surgery, and ancillary cases).
Faxes, tracks, and monitors coding denials and appeals on both inpatient and outpatient cases. Reviews coding insurance denials and refers clinical coding denials to the CDI Physician Advisors.
Resolves insurance denials that have been accepted by updating the coding and send for rebilling if required.
Generate coding appeals for insurance denials with sound arguments and based on coding guidelines and conventions.
Generates coding appeals as a result of CDI Physician Advisor reviews suggesting appeal. Coordinates Peer to Peer requests with third party payers and CDI Physician Advisors and prepares for meeting.
Researches and resolves problems referred by coders and provides prompt feedback.
Provides input on performance of coders and audit information to supervisor for performance evaluations.
Provides information to physicians and other health care staff regarding current coding practices and changes in 3rd party, state and federal regulations and guidelines.
Provides training and serves as a general resource to assist other coders and members of department staff.
Provides training to Physicians, non-physician providers and their support staff on coding guidelines and conventions.
Participates in and provides education sessions as needed on specific coding topics at huddle meetings and other forums.
Reviews, analyzes and abstracts physician/other documentation for diagnoses, procedures, ancillary testing, medications, laboratory and other services provided.
Communicates with physicians and other health care staff to obtain missing information or to clarify existing information.
Reviews edits generated from PWC SMART software, resolves, and educates coding staff.
Utilizes a variety of software (e.g. Optum, Epic, PWC SMART, MS Office, Audit Manager etc.) to compile and validate medical information.

Education Requirements:

Associate degree in Health Information Management or related field or an equivalent combination of education, training, and experience.
Successful completion of the UNC HCS IP or OP Coder Proficiency Test as applicable.

Licensure/Certification Requirements:

Must have one of the following: - AHIMA (American Health Information Management Association) certification and credential - AAPC (American Academy of Professional Coders) certification and credential

Professional Experience Requirements:

If associate's degree: Five (5) years of experience in medical coding or acute care consisting of both IP and OP coding

.• If High School Diploma: Nine (9) years of experience in medical coding or acute care consisting of both IP and OP coding

Knowledge/Skills/and Abilities Requirements:

Strong knowledge of ICD-10/PCS/CPT/HCPCS coding and billing compliance (MS-DRGs/IPPS, APC/OPPS) with excellent analytical and data mining skills. Ability to effectively participate and supervise projects, plan and implement programs, and evaluate outcomes. Ability to effectively work directly with various levels of staff (including on-site and remote) as well as manage vendor relationships and expectations. Must possess strong communication skills, both written and verbal. Exhibits effective organizational skills, time management, and management of multiple priorities. Ability to make effective and persuasive presentations on complex topics to management and physicians. Ability to teach and mentor coders and physicians on complex coding systems. Ability to have an excellent balance of being highly productive and yet produce high quality work. Must be able to create strong argument based on solid coding guidelines in generating appeals. Ability to interpret federal and state regulations as they relate to coding and compliance.

Medical Coder Auditor-HIM Coding & CDI Quality ID-2440

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Common Interview Questions And Answers

1. HOW DO YOU PLAN YOUR DAY?

This is what this question poses: When do you focus and start working seriously? What are the hours you work optimally? Are you a night owl? A morning bird? Remote teams can be made up of people working on different shifts and around the world, so you won't necessarily be stuck in the 9-5 schedule if it's not for you...

2. HOW DO YOU USE THE DIFFERENT COMMUNICATION TOOLS IN DIFFERENT SITUATIONS?

When you're working on a remote team, there's no way to chat in the hallway between meetings or catch up on the latest project during an office carpool. Therefore, virtual communication will be absolutely essential to get your work done...

3. WHAT IS "WORKING REMOTE" REALLY FOR YOU?

Many people want to work remotely because of the flexibility it allows. You can work anywhere and at any time of the day...

4. WHAT DO YOU NEED IN YOUR PHYSICAL WORKSPACE TO SUCCEED IN YOUR WORK?

With this question, companies are looking to see what equipment they may need to provide you with and to verify how aware you are of what remote working could mean for you physically and logistically...

5. HOW DO YOU PROCESS INFORMATION?

Several years ago, I was working in a team to plan a big event. My supervisor made us all work as a team before the big day. One of our activities has been to find out how each of us processes information...

6. HOW DO YOU MANAGE THE CALENDAR AND THE PROGRAM? WHICH APPLICATIONS / SYSTEM DO YOU USE?

Or you may receive even more specific questions, such as: What's on your calendar? Do you plan blocks of time to do certain types of work? Do you have an open calendar that everyone can see?...

7. HOW DO YOU ORGANIZE FILES, LINKS, AND TABS ON YOUR COMPUTER?

Just like your schedule, how you track files and other information is very important. After all, everything is digital!...

8. HOW TO PRIORITIZE WORK?

The day I watched Marie Forleo's film separating the important from the urgent, my life changed. Not all remote jobs start fast, but most of them are...

9. HOW DO YOU PREPARE FOR A MEETING AND PREPARE A MEETING? WHAT DO YOU SEE HAPPENING DURING THE MEETING?

Just as communication is essential when working remotely, so is organization. Because you won't have those opportunities in the elevator or a casual conversation in the lunchroom, you should take advantage of the little time you have in a video or phone conference...

10. HOW DO YOU USE TECHNOLOGY ON A DAILY BASIS, IN YOUR WORK AND FOR YOUR PLEASURE?

This is a great question because it shows your comfort level with technology, which is very important for a remote worker because you will be working with technology over time...

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Other Jobs You May Be Interested In

Medical Coder Auditor-HIM Coding & CDI Quality ID-2440

Common Interview Questions And Answers

1. HOW DO YOU PLAN YOUR DAY?

2. HOW DO YOU USE THE DIFFERENT COMMUNICATION TOOLS IN DIFFERENT SITUATIONS?

3. WHAT IS "WORKING REMOTE" REALLY FOR YOU?

4. WHAT DO YOU NEED IN YOUR PHYSICAL WORKSPACE TO SUCCEED IN YOUR WORK?

5. HOW DO YOU PROCESS INFORMATION?

6. HOW DO YOU MANAGE THE CALENDAR AND THE PROGRAM? WHICH APPLICATIONS / SYSTEM DO YOU USE?

7. HOW DO YOU ORGANIZE FILES, LINKS, AND TABS ON YOUR COMPUTER?

8. HOW TO PRIORITIZE WORK?

9. HOW DO YOU PREPARE FOR A MEETING AND PREPARE A MEETING? WHAT DO YOU SEE HAPPENING DURING THE MEETING?

10. HOW DO YOU USE TECHNOLOGY ON A DAILY BASIS, IN YOUR WORK AND FOR YOUR PLEASURE?

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