Coding Integrity Specialist

R1 RCM•Remote, NH, NH

6d•Onsite

About The Position

R1 is the leading provider of technology-driven solutions that transform the patient experience and financial performance of hospitals, health systems and medical groups. We are the one company that combines the deep expertise of a global workforce of revenue cycle professionals with the industry’s most advanced technology platform, encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our Coding Integrity Specialist, you will work with the Coding Integrity Manager and Director of Coding Operations to establish open lines of communication regarding potential coding quality concerns. Every day you will lead, coordinate, and perform coding quality reviews. To thrive in this role, you must possess strong analytical skills and the ability to comprehend and analyze large quantities of operational data, the ability to review complex medical records, and a strong ability to multi-task and prioritize work assignments.

Requirements

Bachelor's or associate’s degree in HIM related fields or CCS credential is required.
Minimum 5 years of inpatient coding.
Strong analytical skills and ability to comprehend and analyze large quantities of operational data.
Ability to review complex medical records.
Strong ability to multi-task and prioritize work assignments.

Responsibilities

Conduct complex coding reviews related to reimbursement, public reporting, and pay for performance.
Collaborate with the CDI team, assisting with the resolution of documentation inconsistencies, DRG variances, and CDI and internal operations to ensure KPIs, SLA, RIS, and DNFB requirements.
Ensure that the DRG or reimbursement accurately reflects the services/utilization of resources provided by the hospital to optimize the impacts of case mix index reporting.
Collaborate with hospital/client leadership to validate proper coding for appropriate reimbursement for specific service lines and technology which assists hospitals in determining if that technology is a positive return on investment.
Perform second level focused pre-bill and post-bill account reviews to ensure accurate coding, review for quality and risk (HAC, PSI, Mortalities, Core Measures and CMS Initiatives) and escalation for final review which may include approval for write-off.
Conduct complex 360 coding reviews which include identification and correction of coding, and trending for the following issues: documentation, coding denials i.e medical necessity, billing, and charging.
Evaluate for coding accuracy/specificity to assist with preventing possible loss of revenue for the hospital related to value-based payment programs and public reporting.
Provide education/feedback to coders/coding managers regarding coding corrections via automated individual notifications.
Identify coding trends that require formal education by the R1 Education and Training team and work with integration teams and project management teams to test and give feedback on updates to systems and mappings.
Perform ad hoc, Cloudmed DRG Validation Reviews or requests based on client specific wants or needs.