Corporate Coding Analyst

Orlando Health•Town of Berlin, NY

2d•Onsite

About The Position

Reviews, analyzes, and resolves accounts that have failed coding and charge related edits, including medical necessity, National Correct Coding Initiative (NCCI), Medicare Outpatient Code Editor (OCE), and other exceptions requiring clinical/coding expertise.

Requirements

Associates degree in business, healthcare, or related field required. Four (4) years of directly related work experience may substitute for the Associates degree (in addition to requirements listed in the Experience section).
Medical terminology required.
Current coding certification (e.g., RHIA, RHIT, CPC, CCS) from AAPC or AHIMA required at the time of hire or must obtain within 6 months of hire.
Two (2) years of Revenue Cycle experience.
Extensive PC and Excel experience is required.
Expertise in health records review and abstracting of required data to satisfy CCI and MN edits.
Exceptional understanding of electronic medical records (EMR) and charge management.
Extensive knowledge of ICD-10-CM, CPT, HCPCS, and modifiers.

Nice To Haves

EPIC Experience a plus.

Responsibilities

Extracts statistical data, performs Root Cause Analysis to generates supporting trends reports, and notifies Clinical Liaisons and Manager(s) of any trends identified.
Works assigned Epic work queues specializing in assessment and correction of Correct Coding Initiative (CCI) and Medical Necessity (MN) Edits and post bill denials relating to the same.
Manages and prioritizes tasks to meet deadlines for any projects and audits assigned.
Performs documentation reviews of CCI and MN to necessitate clean claims and denial reconciliation.
Provides ad-hoc multivariate reports to management.
Works closely with the Revenue Integrity Clinical Liaisons to assure reconciliation of edits to meet department and organization goals.
Able to locate and interpret local coverage determination (LCD) from our MAC (First Coast) and national coverage determination (NCD) from CMS.
Assists with the training of new Revenue Integrity team members.
Interacts independently to coordinate edit resolution workflow.
Demonstrates exemplary customer service and critical thinking skills to include problem resolution and process improvement skills.
Communicates cooperatively and constructively with multi-disciplinary teams.
Demonstrates professional verbal and written communication skills.
Provides statistical reports to management as requested.
Maintains reasonably regular, punctual attendance consistent with Orlando Health policies, the ADA, FMLA, and other federal, state, and local standards.
Maintains compliance with all Orlando Health policies and procedures.
Maintains established work production standards.
Works as a team member in facilitating efficient and effective problem solving to meet goals.
Assumes responsibility for professional growth and development.
Attends department meetings as required.