Coder Analyst

Avera•Sioux Falls, SD

3d•Onsite

About The Position

Accountable to coordinate National Coverage and Determination (NCD) policies, Local Coverage Determination (LCD) policies, coverage policies for various payers and Medicare articles and any other activities related to medical necessity throughout Avera. Coordination of medical necessity activities includes: implementation of policy validation processes, education to departments on medical necessity guidelines, running reports for coverage review of new or existing policies, supporting appeals process, streamlining workflow for medical necessity, serving on committees, and other duties as necessary.

Requirements

Must be able to work the hours specified.
Visual acuity adequate to perform position duties.
Ability to communicate effectively with others.
Ability to hear, understand and distinguish speech and other sounds.
Certified Coding Associate (CCA) - American Health Information Management Association (AHIMA) within 180 Days or Certified Coding Specialist - Physician-based (CCS-P) - American Health Information Management Association (AHIMA) within 180 Days or Certified Coding Specialist (CCS) - American Health Information Management Association (AHIMA) within 180 Days or Registered Health Information Administrator (RHIA) - American Health Information Management Association (AHIMA) within 180 Days or Registered Health Information Tech (RHIT) - American Health Information Management Association (AHIMA) within 180 Days.

Nice To Haves

Associate's in Health Information Technology
Bachelor's in Health Information Administration
1-3 years of coding experience

Responsibilities

Establish goals for processing, researching and problem solving new, modified and deleted LCD and NCD policies as well as communicating essential information to appropriate departments and staff.
Support coders/managers with software application inconsistencies for LCD/NCD policies by communicating with vendors and hospital leaders as necessary.
Provide presentations to staff as necessary for information pertaining to LCDs/NCDs.
Responsible to collaborate and coordinate activities related to Medicare LCDs and NCDs.
Review Medical Necessity ABN process and other Notices of Non-Coverage forms annually, and more often as necessary, to ensure most recent forms are supported and prices are aligned within parameters regulated by Medicare and other payers.
Serve as liaison for employee training on front end medical necessity tools such as installations, on-going education, proper functionality, and creation of new pick lists as necessary.
Reconcile, track and trend edits through eProvider Solutions (ePS) Medical Necessity edits for correct processing of claims on various patient types and eliminate inefficiencies when possible.
Communicate with CDM team on any trends identified that require adjustments to code assignment in the chargemaster and provide updates as necessary to support compliance.
Collaborate with coders/managers on front end medical necessity edits that could impact back end edits to work towards a more streamlined approach for process improvement for accurate coding and claim submission.
Review and keep informed of billing and coding edits relevant to this position such as regulatory guidelines and keeping current with payer specific references such as the Medicare Administrative.