by Irma Moore | Dec 30, 2024 | Uncategorized
Palestine, Texas
REMOTE POSITION
The Director of Coding will plan, organize, and manage the professional coding to meet the mission. The Director will ensure that accurate, coded data exists for optimal reimbursement by the organization and coordinate all quality and compliance monitoring of assignments for professional services.
Supervisory Responsibilities:
• Oversees the daily operations of the coding unit including workload and staffing; hiring, disciplining, and performance appraisals; training; and monitoring quality of work.
• Develops long-range and short-term goals, objectives, plans, and programs and ensures they are implemented.
• Coach and build talent by empowering and providing feedback, instruction, and development to coding staff.
Duties/Responsibilities:
• Evaluate the impact of innovations and changes in programs, policies, and procedures. Designs and implements systems and methods to improve data accessibility. Identifies, assesses, and resolves problems.
• Overseas and monitors the coding services which would include coder productivity and accuracy.
• Compares coding and reimbursement profiles with national and regional norms to identify variations requiring further investigation.
• Reviews claim denials and rejections pertaining to coding and medical necessity issues and, when necessary, implement corrective action plans (such as educational programs) to prevent similar denials and rejections from recurring.
• Interacts with a variety of people who impact the success of the coding program, and functions as a facilitator, liaison, and/or motivator.
• Driving standardization in Coding services, to ensure consistency in education programs, timely regulatory updates, and adherence to compliance initiatives.
• Trending and analysis of benchmark data to identify and remediate missing revenue due to clinical coding.
Required Skills/Abilities:
• Extensive knowledge of coding principles and guidelines.
• Extensive knowledge of hospital/technical and professional services reimbursement systems.
• Extensive knowledge of federal, state, and payer-specific regulations and policies pertaining to documentation, coding, and billing for professional and technical services.
• Strong managerial, leadership, and interpersonal skills.
• Excellent written and oral communication skills.
• Excellent analytical skills.
• Ability to travel to market locations as necessary.
Qualifications
Education and Experience:
• Five years of professional coding (in-patient and out-patient) experience required.
• CPC certification required. CPMA preferred.
• Strong experience in working with multi-specialty medical groups and providing direction to senior leadership.
Physical Requirements:
• Prolonged periods of sitting at a desk and working on a computer.
• Must be able to lift 15 pounds at times.
by Irma Moore | Dec 30, 2024 | Uncategorized
Fully Remote
This position manages Revenue Integrities Clinical Data Section, which is accountable for: coding and abstracting the medical records of Provider Based practice outpatient practice clinic claims i; preparing statistical analysis of medical records data; compiling, analyzing and summarizing data from medical records into various formats. The output of this Section is used for: meeting hospital licensure requirements; financial and billing purposes, which includes the identification and determination of appropriate reimbursement under inpatient and outpatient prospective payment systems; maintenance of acceptable accounts/receivables and Pre A/R levels; compliance with internal and external regulatory agencies, such as Quality Improvement Organizations, the Centers for Medicare & Medicaid Services, and The Joint Commission.
Required Minimum Knowledge, Skills, and Abilities (KSAs)
1. Education: Advanced education which should include communication and mathematical/statistical skills and/or extensive knowledge in organization, research and analysis normally acquired through the completion of Health Record Administration/ Technician /Science Bachelor’s/Associate Degree program, preferred.
2. License/Certifications: Certification in one of the follow areas required: RHIA/RHIT, CCS, CPC. Skilled in ICD10 diagnosis and CPT coding and knowledge of Provider Based Billing practices.
3. Experience: A minimum of two years prior successful supervisory experience required; Experience with EPIC, claim edit processes, encoder software and CDI programs, preferred. 4. Full working knowledge of: medical information and revenue cycle systems; Grouper and Severity of Illness Systems; medical record systems, medical terminology, anatomy, physiology, pathophysiology, microbiology, and pharmacology; State, Federal and Joint Commission requirements pertaining to medical records; Provider Based payment systems, preferred.
5. Demonstrated abilities to: correctly interpret and apply Federal regulations and PRO requirements in the interpretation of various billing guidelines (i.e., medical necessity, resident supervision policies, correct coding initiative, etc. Ability to direct concurrent and retrospective coding reviews and provide physician education, required
6. Effective skills in leadership, communications, coaching, planning, motivation, and establishing effective working relationships with at all levels of staffing in the organization.
Additional Information
With a career at any of the MaineHealth locations across Maine and New Hampshire, you’ll be working with health care professionals that truly value the people around them – both within the walls of the organization and the communities that surround it.
We offer benefits that support an individual’s needs for today and flexibility to plan for tomorrow – programs such as paid parental leave, a flexible work policy, student loan assistance, training and education, along with well-being resources for you and your family.
MaineHealth remains focused on investing in our care team and developing an inclusive environment where you can thrive and feel supported to realize your full potential. If you’re looking to build a career in a place where people help one another deliver best-in-class care, apply today.
by Irma Moore | Dec 30, 2024 | Uncategorized
Job Description
Align yourself with an organization that has a reputation for excellence. Cedars-Sinai was awarded the National Research Corporation’s Consumer Choice Award 19 years in a row for providing the highest-quality medical care in Los Angeles. We were also awarded the Advisory Board Company’s Workplace of the Year. This role provides excellent exposure, and we offer an outstanding benefits’ package that includes health care, generous time off and a 403(B). Join us! Discover why U.S. News & World Report has named us one of America’s Best Hospitals.
What will I be doing in this role?
The Revenue Cycle Analyst is responsible for the development, assessment and quantification of trends. This will require direct working relationships with management and key staff members, in addition to key members of Finance and Medical Network and Medical Center Departments. The primary duties of this role include:
- Analyzing trends to determine where variances are occurring and develop reports to assess these variances.
- Summarizing information, data, and recommendations, and preparing presentation materials. May present findings to management.
- Making recommendations based upon overall analysis to effectively monitor areas of opportunity/risk.
- Creating/developing regular and ad-hoc reports.
- Payor Policy analysis and review.
- Denial and Revenue Cycle trending.
- Using independent judgment to resolve issues.
- Completing complex/special assignments.
#Jobs-Indeed
Qualifications
Requirements:
- High School Diploma or GED required. Bachelor’s degree in finance, economics, business or a related field preferred.
- A minimum of 1 year of proven experience as an analyst (revenue cycle, data, financial, business, or related) preferred.
- A minimum of 3 years of proven experience in billing and collections revenue cycle experience required.
- Experience in Healthcare delivery systems with knowledge of CPT/HCPC, ICD-10 coding, clearinghouse, EDI claims and remittance advice processing, and Epic Revenue Cycle Applications (i.e. ADT/Prelude, Cadence, Resolute PB or HB) highly preferred.
Why work here?
Beyond outstanding employee benefits including health and dental insurance, vacation, and a 403(b) Cedar-Sinai takes pride in hiring the best employees. Our accomplished staff reflects the culturally and ethnically diverse community we serve. They are proof of our dedication to creating a dynamic, inclusive environment that fuels innovation.Req ID : 6403Working Title : Revenue Cycle Analyst (Remote)Department : CSRC PB – GroupBusiness Entity : Cedars-Sinai Medical CenterJob Category : Patient Financial ServicesJob Specialty : Revenue IntegrityOvertime Status : EXEMPTPrimary Shift : DayShift Duration : 8 hourBase Pay : $36.31 – $56.28
by Irma Moore | Dec 30, 2024 | Uncategorized
Job Description
Align yourself with an organization that has a reputation for excellence. Cedars-Sinai was awarded the National Research Corporation’s Consumer Choice Award 19 years in a row for providing the highest-quality medical care in Los Angeles. We were also awarded the Advisory Board Company’s Workplace of the Year. This role provides excellent exposure, and we offer an outstanding benefits’ package that includes health care, generous time off and a 403(B). Join us! Discover why U.S. News & World Report has named us one of America’s Best Hospitals.
What will I be doing in this role?
The Revenue Cycle Analyst is responsible for the development, assessment and quantification of trends. This will require direct working relationships with management and key staff members, in addition to key members of Finance and Medical Network and Medical Center Departments. The primary duties of this role include:
- Analyzing trends to determine where variances are occurring and develop reports to assess these variances.
- Summarizing information, data, and recommendations, and preparing presentation materials. May present findings to management.
- Making recommendations based upon overall analysis to effectively monitor areas of opportunity/risk.
- Creating/developing regular and ad-hoc reports.
- Payor Policy analysis and review.
- Denial and Revenue Cycle trending.
- Using independent judgment to resolve issues.
- Completing complex/special assignments.
#Jobs-Indeed
Qualifications
Requirements:
- High School Diploma or GED required. Bachelor’s degree in finance, economics, business or a related field preferred.
- A minimum of 1 year of proven experience as an analyst (revenue cycle, data, financial, business, or related) preferred.
- A minimum of 3 years of proven experience in billing and collections revenue cycle experience required.
- Experience in Healthcare delivery systems with knowledge of CPT/HCPC, ICD-10 coding, clearinghouse, EDI claims and remittance advice processing, and Epic Revenue Cycle Applications (i.e. ADT/Prelude, Cadence, Resolute PB or HB) highly preferred.
Why work here?
Beyond outstanding employee benefits including health and dental insurance, vacation, and a 403(b) Cedar-Sinai takes pride in hiring the best employees. Our accomplished staff reflects the culturally and ethnically diverse community we serve. They are proof of our dedication to creating a dynamic, inclusive environment that fuels innovation ID : 6403Working Title : Revenue Cycle Analyst (Remote)Department : CSRC PB – Group Business Entity : Cedars-Sinai Medical Center Job Category : Patient Financial Services Job Specialty : Revenue Integrity Overtime Status : EXEMPT Primary Shift : Dayshift Duration : 8 hour Base Pay : $36.31 – $56.28
by Irma Moore | Dec 30, 2024 | Uncategorized
Employment Type:
Full time
Shift:
Description:
Posting
POSITION PURPOSE
Provides high level technical competency and subject matter expertise analyzing physician/provider documentation in Inpatient health records to determine the principal diagnosis, secondary diagnoses, principal procedure and secondary procedures. Assigns appropriate Medicare Severity Diagnosis Related Groups (MS-DRG), All Patient Refined DRGs (APR), Present on Admission (POA), as well as Severity of Illness (SOI) & Risk of Mortality (ROM) indicators for Inpatient records. Identifies Hospital Acquired Conditions (HAC), Patient Safety Indicators (PSI) to ensure accurate hospital reimbursement.
Utilizes encoder software applications, which includes all applicable online tools and references in the assignment of International Classification of Diseases, Clinical Modification (ICD-CM) diagnosis and procedure codes, MS-DRG, APR DRG, POA, SOI & ROM assignments.
Assigns appropriate code(s) by utilizing coding guidelines established by:
• The Centers for Disease Control (CDC), ICD-CM Official Coding Guidelines for Coding and Reporting, Centers for Medicare/Medicaid Services (CMS) ICD-PCS Official Guidelines for Coding and Reporting
• American Hospital Association (AHA) Coding Clinic for International Classification of Diseases, Clinical Modification
• American Health Information Management Association (AHIMA) Standards of Ethical
Coding
• Revenue Excellence/HM coding procedures and guidelines
ESSENTIAL FUNCTIONS
Knows, understands, incorporates, and demonstrates the Trinity Health Mission, Vision, and Values in behaviors, practices, and decisions.
Navigates the patient health record and other computer systems/sources to accurately determine diagnosis and procedures codes, MS-DRGs, APR DRGs, and identify HACs and PSIs or other indicators that could impact quality data and hospital reimbursement.
Codes Inpatient health records utilizing encoder software and consistently uses online tools to support the coding process and references to assign ICD codes, MS-DRG, APR DRGs, POA, SOI & ROM indicators.
Reviews Inpatient health record documentation, as part of the coding process, to assess the presence of clinical evidence/indicators to support diagnosis code and MS-DRG, APR DRG assignments to potentially decrease denials.
Works Inpatient claim edits and may code consecutive/combined accounts to comply with the 72-hour rule and other account combine scenarios.
Adheres to Inpatient coding quality and productivity standards established by Revenue Excellence/HM.
Demonstrates knowledge of current, compliant coder query practices when consulting with physicians, Clinical Documentation Specialists (CDS) or other healthcare providers when additional information is needed for coding and/or to clarify conflicting or ambiguous documentation.
Utilizes EMR communication tools to track missing documentation or Inpatient queries that require follow-up to facilitate coding in a timely fashion.
Works with HIM and Patient Business Services (PBS) teams, when needed, to help resolve billing, claims, denial and appeals issues affecting reimbursement.
Maintains CEUs as appropriate for coding credentials as required by credentialing associations.
Maintains current knowledge of changes in Inpatient coding and reimbursement guidelines and regulations as well as new applications or settings for Inpatient coding e.g., Hospital at Home.
Identifies, and attempts to problem solve, coding and/or EMR workflow issues that can impact coding.
Exhibits awareness of health record documentation or other coding ethics concerns. Notifies appropriate leadership for assistance, resolution when appropriate.
Performs other duties as assigned by Leadership.
Maintains a working knowledge of applicable coding and reimbursement Federal, State and local laws and regulations, the Compliance Accountability Program, Code of Ethics, as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical and professional behavior
MINIMUM QUALIFICATIONS
Completion of an AHIMA-approved coding program or Associate’s degree in Health Information Management or a related field or an equivalent combination of years of education and experience is required. Bachelor’s degree in Health Information Management (HIM) or related healthcare field is preferred.
Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), or Certified Coding Specialist (CCS) is required.
Three (3) years of current acute care or Inpatient coding experience is required. Extensive, comprehensive working knowledge of medical terminology, Anatomy and Physiology, diagnostic and procedural coding and MS-DRG, APR DRG assignment. Must be proficient on identifying POA, SOI and ROM indicators for Inpatient records as well as HACs and PSIs to ensure accurate hospital reimbursement.
Current experience utilizing encoding/grouping software and Computer Assisted Coding (CAC) is preferred.
Ability to use a standard desktop/laptop, email and other Windows applications, if needed, Internet and web-based training tools preferred.
Strong oral and written communication skills. Ability to communicate effectively with individuals and groups representing diverse perspectives.
Ability to research, analyze and assimilate information from various sources based on technical and experience-based knowledge. Must exhibit critical thinking skills, strong problem- solving skills and the ability to prioritize workload.
Excellent organizational and customer service skills. Ability to perform frequent detailed tasks and provide productivity standard driven results. Ability to adapt to change and be flexible with work priorities and interruptions.
Must be comfortable functioning in a 100% virtual, collaborative, shared leadership environment. with minimal supervision and able to exercise independent judgement.
Must possess a personal presence that is characterized by a sense of honesty, integrity, and caring with the ability to inspire and motivate others to promote the philosophy, mission, vision, goals, and values of Trinity Health.
PHYSICAL AND MENTAL REQUIREMENTS AND WORKING CONDITIONS
Must be able to set and organize own work priorities and adapt to them as they change frequently. Must be able to work concurrently on a variety of tasks/projects in physical or virtual environments that may be stressful with individuals having diverse personalities and work styles.
Must possess the ability to comply with Trinity Health policies and procedures.
Must be able to spend majority of work time utilizing a computer, monitor, and keyboard.
Must be able to work with interruptions and perform detailed tasks.
If applicable, involves a wide array of physical activities, primarily standing, sitting and reading. Must be able to sit for long periods of time.
Must be able to travel to various Trinity Health sites as necessary.
Hourly Pay Range: $26.88 – $ 40.32
If applicable, telecommuting (working remotely), must be able to comply with Trinity Health’s and the Region/HM Working Remote Policy.
The above statements are intended to describe the general nature and level of work being performed by persons assigned to this classification. They are not to be construed as an exhaustive list of duties so assigned.
Our Commitment to Diversity and Inclusion
Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core Values, we integrate diversity, equity, and inclusion in all that we do. Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A diverse and inclusive workforce provides the most accessible and equitable care for those we serve. Trinity Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by law.
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