HIM Coding Review Specialist Inpatient - FT - REMOTE
About The Position
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. Capital Health recognizes that attracting the best talent is key to our strategy and success as an organization. As a result, we aim for flexibility in structuring competitive compensation offers to ensure we can attract the best candidates. Pay Range: $62,108.80 - $91,765.75 Scheduled Weekly Hours: 40 Position Overview HIM Coding Rev Spec Inpatient Remote CANDIDATES MUST RESIDE IN THE NEW JERSEY/PENNSYLVANIA AREA 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.
Requirements
- High School diploma or equivalent.
- CCS required.
- 5 Years of inpatient coding experience necessary
- Prior experience with an encoder and EMR computer systems.
- Possesses excellent organizational, interpersonal, verbal, and written communication skills.
- Ability to effectively manage multiple projects simultaneously and ability to respond quickly in a fast paced environment.
Nice To Haves
- Associate's degree preferred.
- Knowledge of denials management preferred.
Responsibilities
- 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.
Benefits
- Medical Plan
- Prescription drug coverage & In-House Employee Pharmacy
- Dental Plan
- Vision Plan
- Flexible Spending Account (FSA) - Healthcare FSA - Dependent Care FSA
- Retirement Savings and Investment Plan
- Basic Group Term Life and Accidental Death & Dismemberment (AD&D) Insurance
- Supplemental Group Term Life & Accidental Death & Dismemberment Insurance
- Disability Benefits – Long Term Disability (LTD)
- Disability Benefits – Short Term Disability (STD)
- Employee Assistance Program
- Commuter Transit
- Commuter Parking
- Supplemental Life Insurance - Voluntary Life Spouse - Voluntary Life Employee - Voluntary Life Child
- Voluntary Legal Services
- Voluntary Accident, Critical Illness and Hospital Indemnity Insurance
- Voluntary Identity Theft Insurance
- Voluntary Pet Insurance
- Paid Time-Off Program
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
Number of Employees
1,001-5,000 employees
