Coding Quality Specialist

St. Luke's Health System•Boise, ID

About The Position

At St. Luke’s, we pride ourselves on fostering a workplace culture that values diversity, promotes collaboration, and prioritizes employee well-being. Our commitment to excellence in patient care extends to creating an environment where our team can thrive both personally and professionally. With opportunities for growth, competitive benefits, and a supportive community of colleagues, St. Luke’s is truly a great place to work. What You Can Expect: Under limited supervision, the Coding Quality Specialist is responsible for ensuring coding practices and procedures are in compliance with all applicable state and federal laws, regulations, rules, and policies of governmental authorities and payers. Demonstrates advanced competency with coding and review of medical record documentation to accurately assign codes based on state and federal regulations and company policies. Reviews reimbursement denials from third party carriers associated with inappropriate diagnosis or procedure coding. Responds promptly to questions from coders and utilizes various reports for the analysis and identification of patterns or trends when investigating issues. Analyzes and reviews documentation for appropriateness and completeness to ensure documentation supports the level or type of services billed and documentation is in compliance with all guidelines and regulations. Apply advanced coding knowledge to problem solve unique or new cases resulting in the assignment and sequencing of diagnosis and procedure codes. Communicates with department management regarding complex coding issues, auditing issues, and current coding regulations. Collaborates with department leadership to continually improve and maintain the efficiency and accuracy of the overall coding process. Interprets federal and state regulations related to coding and integrates applicable regulations into current processes. Performs other duties and responsibilities as assigned.

Requirements

Associates degree or experience in lieu of degree
4 years relevant experience
Must have at least one of the following credentials: RHIA (Registered Health Information Administrator), RHIT (Registered Health Information Technician), CCS (Certified Coding Specialist), CCS-P (Certified Coding Specialist Physician based), CPC (Certified Professional Coder), CPC-H (Certified Professional Coder Hospital), COC (Certified Outpatient Coder), CIC (Certified Inpatient Coder), or CRC (Certified Risk Adjustment Coder).

Responsibilities

Ensuring coding practices and procedures are in compliance with all applicable state and federal laws, regulations, rules, and policies of governmental authorities and payers.
Demonstrates advanced competency with coding and review of medical record documentation to accurately assign codes based on state and federal regulations and company policies.
Reviews reimbursement denials from third party carriers associated with inappropriate diagnosis or procedure coding.
Responds promptly to questions from coders and utilizes various reports for the analysis and identification of patterns or trends when investigating issues.
Analyzes and reviews documentation for appropriateness and completeness to ensure documentation supports the level or type of services billed and documentation is in compliance with all guidelines and regulations.
Apply advanced coding knowledge to problem solve unique or new cases resulting in the assignment and sequencing of diagnosis and procedure codes.
Communicates with department management regarding complex coding issues, auditing issues, and current coding regulations.
Collaborates with department leadership to continually improve and maintain the efficiency and accuracy of the overall coding process.
Interprets federal and state regulations related to coding and integrates applicable regulations into current processes.
Performs other duties and responsibilities as assigned.