CODING SPEC-CLINIC
US-TN-Knoxville
Covenant Health
Req #: 65650
Type: Full-Time
Overview: Coding Specialist, Centralized Coding Full Time, 80 Hours Per Pay Period, Day Shift Covenant Health Overview: Covenant Health is East Tennessee's top-performing healthcare network with 10 hospitals and over 85 outpatient and specialty services, and Covenant Medical Group, our area's fastest-growing physician practice division. Headquartered in Knoxville, Covenant Health is a community-owned, not-for-profit healthcare system and the area's largest employer with over 11,000 employees. Covenant Health is the only healthcare system in East Tennessee to be named six times by Forbes as a Best Employer. Position Summary: This individual provides leadership, direction, and training for the coding staff. Working directly with the physicians, Manager of Corporate Coding Services, Director of Registration/Admitting, and medical staff education efforts, serves as the user advocate between Health Information Management (HIM), Clinical Effectiveness, and Registration. Other job duties include: improving health record documentation and coding accuracy, developing and updating all departmental policies and procedures relative to coding, performing quality reviews of coding/abstracting, and focusing on problem solving issues related to denials. Provides assurance that billing practices are complete, accurate, and in compliance with state and federal guidelines. Recruiter: Kathleen Rice || kkarnes@covhlth.com || 865-374-5386 Responsibilities: * Oversees through monitoring and by reviewing and auditing the coding staff to ensure position accountabilities and performance criteria are adhered to. * Develops and maintains departmental and hospital policies and procedures and implements new policies and procedures relative to coding. * Educates and assists physicians and clarifies coding versus clinical issues. * Works closely with Registration and Business Office personnel to resolve issues related to claims, coding, pre-cert, and denials appeals, and verifies that appropriate chargemaster rates are used. * Reviews medical record documentation to ensure existing documentation supports diagnostic/procedure code billed per UB 92 or HCFA 1500 form. * Provides education to coding staff and physicians in response to regulatory changes and identified areas of deficiency. * Monitors claim rejections and systematically assesses specific types of denial as it relates to coding and documentation issues, outpatient registration, and the receipt of physician orders. * Attends meetings and provides input as it relates to coding, medical documentation, and reimbursement issues specific to medical billing and regulatory requirements. * Increases awareness of compliance as it relates to coding and documentation. * Facilitates and coordinates education of coding staff in the areas of coding, documentation, case mix, and denials. * Increases understanding of APCs, DRGs, case mix, and denials. * Educates coding staff to proper documentation necessary to support a DRG/APC/Medical Necessity/ROM/SOI. * Integrates documentation, coding, and proper oversight to ensure accurate reimbursement. * Reviews records to verify if the correct code has been assigned. * Assists with all insurance requested audits and provides information to supervisor related to inaccurate and/or missing documentation. * Reviews DRG/APC classifications and educates to maximize level of care assignment for increased reimbursement. * Keeps current on local, state, and federal regulations to ensure compliance. * Keeps current on coding guidelines and communicates to Health Information Manager. Implements corrective actions as indicated to minimize financial risk. * Works with Denials Elimination Group and deals with physician specific issues as it impacts denials. * Ensures LCDs/NCDs are being adhered to by admissions and hospital personnel to ensure qualifying diagnosis covers tests/procedures. * Analyzes denials and coordinates appeals. * Ensures corrective action is taken to prevent denials from reoccurring. * Follows policies, procedures, and safety standards. Completes required education assignments annually. Works toward achieving goals and objectives, and participates in quality improvement initiatives as requested. * Performs other duties as assigned. Qualifications: Minimum Education: None specified; however, must be sufficient to meet the standards for achievement of the below indicated license and/or certification as required by the issuing authority. Minimum Experience: Five or more (5+) years coding experience. Licensure Requirement: RHIA, Coding, or RHIT certification required. Registered Health Information Technologist preferred.
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