Inpatient Clinical & Coding Specialist - Senior

Independent Health • Buffalo, NY

219d • $33 - $38

About The Position

The Clinical & Coding Specialist-Senior will be responsible for reviewing coding and clinical decisions on cases involving complex clinical presentation with correlating coding complexity. They will aid in training other team members, evaluating appeals, and share audit trends across the team. Expertise and proficiency demonstrated by long-standing, consistent results, advanced coding knowledge and auditing skills evidenced by their ability to train others, to identify coding patterns and share knowledge and audit tips across the team. The Clinical & Coding Specialist-Senior will support the leadership in Hospital Audit in accomplishing all aspects of the audit plan.

Requirements

• Associates degree required. Bachelor's degree preferred. An additional two (2) years of experience will be considered in lieu of degree.
• Minimum of one of the following certifications or licensures: Certified Inpatient Coder (CIC), Registered Health Information Management Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Clinical Documentation Specialist (CCDS), American Health Information Management Association (CCS-H, CCS-P), Certification Denials and Appeals Management (C-DAM), or NYS licensed RN or LPN required. LPN or RN preferred.
• Four (4) years of experience working in a clinical setting or utilizing a coding system (ICD-10 or PCS) required.
• Knowledge of ICD-10-CM and ICD-10-PCS coding systems, as well as respective reimbursement methodologies associated with each coding system preferred.
• Experience and proficiency reviewing health care delivery against clinical quality, as well as financial established guidelines.
• Analytical and critical thinking skills.
• Ability to ensure that clinical information translates correctly into claim coding compliance with requested data set.
• Ability to prepare quantitative and qualitative studies at conclusion of audit.
• Ability to recalculate reimbursement following conclusion of audit in accordance with corporate provider contracts and/or Independent Health policy and procedures.
• Autonomous/independent worker, minimal supervision, including process management skills.
• Ability to serve as effective team member of cross-functional teams and/or proven ability to facilitate teams and foster collaboration internally and externally.
• Understanding of organizational business strategies as well as audit and reimbursement related business strategies.
• Organizational skills, verbal & written communication skills with ability to effectively communicate with personnel and providers externally.
• PC/Windows skills with proficiency in Microsoft Word and Excel.
• Experience with remote access - citrix, VPN, external EMR access.
• Knowledge of facility contract reimbursement policies.
• Proven examples of displaying the IH values: Passionate, Caring, Respectful, Trustworthy, Collaborative, and Accountable.

Nice To Haves

• Coding audit experience in an inpatient setting preferred.

Responsibilities

• Assume role of project manager as it relates to the re-engineering of the hospital audit process.
• Responsible for the ongoing management of Inpatient Medical Admission and Readmission audits to include trends of clinical findings and financial recoupment statistics.
• Perform validation of diagnosis and procedure coding by reviewing medical record documentation and/or provider claims data.
• Ensure coding compliance with industry standard ICD-10-CM and ICD-10-PCS coding guidelines and financial policies/contracts.
• Responsible for all reconsideration clinical appeals to include review of records, consultation with Medical Director, response to facilities as well as coordination of all aspects of these functions for external review agent process (Dispute Resolution Agency).
• Serve as the subject matter expert for each audit to include internet research of industry standards (clinical/coding).
• Prepare and present audit results as needed, to various levels of internal senior leadership for approval of financial recoveries, provider education, and/or recommendation for next steps.

Benefits

• Scorecard incentive
• Full range of benefits
• Generous paid time off

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Industry: Insurance Carriers and Related Activities
• Education Level: Associate degree