HIM Coding Review Specialist Inpatient - FT - REMOTE

Capital Health; United States; Remote; USD 50,000 - 90,000; Full time

Job summary

An established industry player is seeking a HIM Coding Rev Spec for a fully remote position. This role involves ensuring compliance with coding rules, interpreting billing guidelines, and enhancing reimbursement processes. The ideal candidate will possess strong coding expertise and excellent communication skills, enabling them to effectively manage coding standards and audits. Join a forward-thinking healthcare organization that values quality patient care and invests in its staff. This is a fantastic opportunity to contribute to a dynamic team while working from the comfort of your home.

Qualifications

• Two years of medical coding experience required.
• CCS certification is mandatory for this role.

Responsibilities

• Verify accurate assignment of diagnoses and procedures.
• Conduct audits and reviews of medical records for coding accuracy.
• Develop educational programs on coding for staff.

Skills

Medical Coding

Compliance Knowledge

Communication Skills

Organizational Skills

Denials Management

Education

High School Diploma

Associate's Degree

CCS Certification

Tools

Encoder Systems

EMR Systems

Job description

Work Shift:

Capital Health is the region's leader in providing progressive, quality patient care with significant investments in our exceptional physicians, nurses and staff, as well as advanced technology. Capital Health is a five-time Magnet-Recognized health system for nursing excellence and is comprised of 2 hospitals. Capital Health Medical Group is made up of more than 250 physicians and other providers who offer primary and specialty care, as well as hospital-based services, to patients throughout the region.

Position Overview:

HIM Coding Rev Spec Inpatient *FULLY REMOTE

JOB CODE:20314

FLSA Exemption Status: Exempt

Telecommuting Eligible: Yes

SUMMARY (BASIC PURPOSE OF THE JOB): Provides expertise in development and maintenance of rules, policies and procedures to ensure organizational compliance with industry standard coding rules and guidelines. Interprets and applies National Uniform Billing Compliance rules, guidelines, laws and industry trends to support claims payment, provider reimbursement and system configuration to proactively address cost efficiencies and compliance requirements. Recommends clinical classification and reimbursement guidelines and standards. Reviews coding in provider contracts and participates in development of coding standards for provider contracts. Performs health data analytics related to reimbursement business and policy decisions.

MINIMUM REQUIREMENTS:

Education: High School diploma or equivalent. Associate's degree preferred. CCS required.

Experience: Two years of medical or hospital coding experience.

Other Credentials: CCS

Knowledge and Skills: Prior experience with an encoder and EMR computer systems. Possesses excellent organizational, interpersonal, verbal, and written communication skills. Knowledge of denials management preferred.

Special Training:

Mental, Behavioral and Emotional Abilities: Ability to effectively manage multiple projects simultaneously and ability to respond quickly in a fast-paced environment.

Usual Work Day: 8 Hours

REPORTING RELATIONSHIPS:

Does this position formally supervise employees? No

If set to YES, then this position has the authority (delegated) to hire, terminate, discipline, promote or effectively recommend such to manager.

ESSENTIAL FUNCTIONS:

• Verifies accurate assignment of diagnoses and procedures within the medical record to comply with federal and state regulations.
• Acts as the primary department expert on DRGs while consistently monitoring regulatory updates and their implementation.
• Conducts regular audits and reviews of medical records at a senior level and assists with external and internal reviews for coding accuracy.
• Reviews claim denials and rejections pertaining to coding and medical necessity issues and exercises discretion and judgement when recommending corrective action plans such as educational programs to prevent similar denials and rejections from occurring in the future.
• Assists in implementation of policy and procedural changes within the department regarding coding and quality issues required by third-party payers and according to recommendations by coding consultants and agencies.
• Develops and coordinates educational and training programs on coding and documentation for department staff, providers, billing staff, and ancillary departments.
• Provides management with various statistical reports, data, and audits information on health information management compliance issues, internal and external quality assurance results and activities, performance improvement activities and other statistical information as required or requested.
• Adapts to changing department demands required for higher department efficiency.
• Liaises with Quality and other departments for validation of HACs, PSIs, and complications, etc. to ensure accurate external reporting. Assists other departments with ICD-10-CM / ICD-10-PCS.
• Performs other duties as assigned.

PHYSICAL DEMANDS AND WORK ENVIRONMENT:

Frequent physical demands include:

Occasional physical demands include: Standing, Walking, Push/Pull, Twisting, Bending, Reaching forward, Reaching overhead, Squat/kneel/crawl, Talk or Hear

Continuous physical demands include: Sitting, Wrist position deviation, Pinching/fine motor activities, Keyboard use/repetitive motion

Lifting Floor to Waist 15 lbs. Lifting Waist Level and Above 15 lbs.

Sensory Requirements include: Accurate Near Vision, Accurate Far Vision, Accurate Depth Perception, Accurate Hearing

Anticipated Occupational Exposure Risks Include the following: N/A

Offers are contingent upon successful completion of our onboarding process and pre-employment physical. Capital Health will require all applicants to have an annual flu vaccine prior to start date, with the exception of individuals with medical and religious exemptions.