EW CODING ANALYST
Type of Opportunity: Full Time
FTE: 1.000000
Exempt: No
Work Schedule: Days
Shift: 1
Location: US:NM:Albuquerque:Rev Hugh Cooper Center
Essential:
High school diploma/GED required. One year healthcare clinical, coding, auditing, compliance or patient financial services related experience. Excellent written and verbal communication skills. Detail and results oriented. Ability to work independently. Medical terminology, ICD-9, CPT-4 and HCPCS knowledge required.
Summary:
With supervision directly supports the following responsibilities of the Enterprise-Wide Coding team: maintain and update enterprise-wide and department coding policies and procedures for PHS; monitor compliance to all external regulatory agency coding rules and regulations; coordinate internal and external enterprise-wide coding audits for all areas within PHS conducting coding; summarize and track internal and external audit results for all of PHS; coordinate and track enterprise-wide training of all PHS coding, audit, physician and clinician personnel; support via tracking the enterprise-wide corrective action plans for coding, audit, physician and clinician personnel identified as low performers; perform medical record and billing reviews of denied and appealed claims with assistance of coder and clinical auditors; compile and analyze Enterprise-Wide Coding scorecard metrics for coding related denials and appeals and overall coding accuracy results based on both internal and external audits; research regulatory agency regulations; correct patient accounts based on internal and external audit findings.
Responsibilities:
Liaison to the Manager, Information Services, Finance/Patient Financial Services, all hospitals, all PMG sites, PHP, Home Health, Albuquerque Ambulance, Compliance and all ancillary departments in addressing functional coding, auditing, compliance and training issues and problems.
Responsible for maintaining accurate, complete and timely documentation in either electronic or hard copy form.
Maintains and disseminates up-to-date technical knowledge of legal and regulatory information from all appropriate jurisdictions concerning the given business area. This includes but is not limited to all ICD-9, CPT-4, HCPCS and APC updates and changes.
Researches coding, billing and charging compliance issues, recommends and implements corrective action plans that assure compliance with regulatory agencies where appropriate.
Responds to inquiries and requests daily regarding coding and auditing issues and problems and ad-hoc analysis for all PHS management.
Gathers and analyzes information and provides recommendations to address and resolve business issues for a specific business group.
Responds to client problems and inquiries via the telephone and e-mail.
Maintains up-to-date working knowledge of all PHS coding and auditing IT applications.
Researches and investigates external and internal customer concerns regarding patient care and/or billing of patient care.
Analyzes and summarizes data from medical record and account audits and communicate results and findings to management.
Documents via information systems the responses and resolutions to both internal and external customer inquiries and issues to ensure high quality and standardized responses as well as tracking and reporting capability.
Provide assistance in audit research and documentation.
Competencies and skills:
Nonessential:
SKILL-Ability to effectively interact with customers to understand their needs and explain data
SKILL-Microsoft Office
Planning and coordinating organizational change
Anticipating & Addressing Customer Needs
Educating Employees, Customers & Transferring Knowledge
Functioning as an Effective Contingent Member
Diagnosing & Resolving Problems
Acquiring & Applying Superior Skills to achieve Quality Outcomes
Functioning as an Effective Team Member
SKILL-Demonstrated ability to communicate effectively in person and via telephone with members, employer groups, brokers, physicians, and physician office staff using strong dialogue and customer service competencies.
SKILL-Written communication
We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, age, religion, sex, national origin, sexual orientation, gender identity, marital status, disability, protected veteran status, or any other characteristic protected by law. Presbyterian Healthcare Services is a drug-free and tobacco-free employer with smoke free campuses.
ApplyEstimated Salary: $20 to $28 per hour based on qualifications.
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