Clinical & Coding Specialist-Senior

Independent Health; United States; Hybrid; USD 46,149 - 52,348; Full time

Benefits offered by this job

Generous paid time off

Scorecard incentive

Full range of benefits

Job summary

Independent Health is seeking a Clinical & Coding Specialist-Senior responsible for reviewing complex clinical cases and coding decisions, supporting audit functions, and training team members. Candidates should have extensive experience with coding compliance and clinical auditing.

The position offers an hourly wage of $33.50 – $38.00 based on skills and experience, along with a generous benefits package.

Qualifications

• Associates degree required. Bachelor’s degree preferred.
• Two years of experience may replace degree requirement.
• Certifications in coding required.
• Minimum of four years experience in a clinical setting.

Responsibilities

• Review coding compliance with industry standards.
• Manage hospital audit processes.
• Validate diagnosis and procedure coding.
• Prepare and present audit results to leadership.

Skills

Analytical skills

PC/Windows skills

Verbal & written communication

Team collaboration

Coding compliance

Education

Associates degree

Bachelor’s degree (preferred)

Certifications (multiple listed)

Experience with coding systems

Tools

Microsoft Word

Microsoft Excel

Remote access tools

Job description

Overview

The Clinical & Coding Specialist-Senior will be responsible for reviewing coding and clinical decisions on cases involving complex clinical presentations with correlating coding complexity. They will aid in training other team members, evaluating appeals, and sharing audit trends across the team. They will support the leadership in Hospital Audit in accomplishing all aspects of the audit plan.

Qualifications

• Associates degree required.
• Bachelor’s degree preferred.
• An additional two (2) years of experience will be considered in lieu of degree.
• Minimum of one of the following certifications or licensures: Certified Inpatient Coder (CIC), Registered Health Information Management Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Clinical Documentation Specialist (CCDS), American Health Information Management Association (CCS-H, CCS-P), Certification Denials and Appeals Management (C-DAM), or NYS licensed RN or LPN required. LPN or RN preferred.
• Four (4) years of experience working in a clinical setting or utilizing a coding system (ICD-10 or PCS) required.
• Coding audit experience in an inpatient setting preferred.
• Knowledge of ICD-10-CM and ICD-10-PCS coding systems, as well as respective reimbursement methodologies associated with each coding system preferred.
• Experience and proficiency reviewing health care delivery against clinical quality, as well as financial established guidelines.
• Analytical and critical thinking skills.
• Ability to ensure that clinical information translates correctly into claim coding compliance with requested data set.
• Ability to prepare quantitative and qualitative studies at conclusion of audit.
• Ability to recalculate reimbursement following conclusion of audit in accordance with corporate provider contracts and/or Independent Health policy and procedures.
• Autonomous/independent worker, minimal supervision, including process management skills.
• Subject matter expert in all coding systems and/or inpatient clinical expertise.
• Ability to serve as effective team member of cross‑functional teams and/or proven ability to facilitate teams and foster collaboration internally and externally.
• Understanding of organizational business strategies as well as audit and reimbursement related business strategies.
• Organizational skills, verbal & written communication skills with ability to effectively communicate with personnel and providers externally.
• PC/Windows skills with proficiency in Microsoft Word and Excel.
• Experience with remote access – citrix, VPN, external EMR access.
• Knowledge of facility contract reimbursement policies.
• Proven examples of displaying the IH values: Passionate, Caring, Respectful, Trustworthy, Collaborative, and Accountable.

Essential Accountabilities

• Assume role of project manager as it relates to the re‑engineering of the hospital audit process.
• Responsible for the ongoing management of Inpatient Medical Admission and Readmission audits to include trends of clinical findings and financial recoupment statistics.
• Perform validation of diagnosis and procedure coding by reviewing medical record documentation and/or provider claims data.
• Ensure coding compliance with industry standard ICD-10-CM and ICD-10-PCS coding guidelines and financial policies/contracts.
• Responsible for all reconsideration clinical appeals to include review of records, consultation with Medical Director, response to facilities as well as coordination of all aspects of these functions for external review agent process (Dispute Resolution Agency).
• Serve as the subject matter expert for each audit to include internet research of industry standards (clinical/coding), that may be used to assist in the creation or revision of Independent Health policies and procedures.
• Prepare and present audit results as needed, to various levels of internal senior leadership for approval of financial recoveries, provider education, and/or recommendation for next steps.

Compensation & Benefits

Immigration or work visa sponsorship will not be provided for this position. Hiring compensation range: $33.50 – $38.00 hourly. Compensation may vary based on factors including but not limited to skills, education, location, and experience. In addition to base compensation, associates may be eligible for a scorecard incentive, full range of benefits and generous paid time off. The base salary range is subject to change and may be modified in the future.

Equal Opportunity & Reasonable Accommodation

As an Equal Opportunity / affirmative action employer, Independent Health and its affiliates will not discriminate in its employment practices due to an applicant’s race, color, creed, religion, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender identity or expression, transgender status, age, national origin, marital status, citizenship and immigration status, physical and mental disability, criminal record, genetic information, predisposition or carrier status, status with respect to receiving public assistance, domestic violence victim status, a disabled, special, recently separated, active duty wartime, campaign badge, Armed Forces service medal veteran, or any other characteristics protected under applicable law.

We are committed to providing reasonable accommodations for qualified individuals with disabilities and disabled veterans. An applicant for employment in need of an accommodation to participate in the application and recruitment process should contact Human Resources at [e-mail].