To review and audit Network Provider medical records for documentation and coding compliance and quality with federal and state laws and regulations.
Responsibilities
Research, develop, and implement standardized processes for quality monitoring of inpatient and outpatient coding and abstracting.
Conduct quality audits for coding according to pre-established criteria, coordinating with the Coding and Reimbursement Specialist.
Assist Management in evaluating coding functions and processes to identify opportunities to improve efficiency and quality.
Implement innovative ideas and process changes.
Attend meetings as required and strive to improve the quality of meetings by taking an active role in meeting topics.
Participate in educational programs, in-services, and training sessions to share expertise and contribute to education and personal growth of new personnel, volunteers, and interning students.
Establish and maintain interdepartmental relationships with Network providers to facilitate cooperation and compliance.
Assist the Physician Network, Revenue Management Department, and other financial departments in clarifying coding to resolve claim edits and assure clean claim submission.
Monitor and evaluate compliance with documentation standards to identify trends, issues, risk areas, and opportunities for education and process improvement.
Collaborate with Management to identify and coordinate educational needs based on audit results and new technologies.
Provide support to the Coding and Reimbursement Specialist of monthly statistics and educational programs to staff on a regular basis.
Provide technical assistance to the Systems Specialist for authorized coding database retrieval and resolution of software and system functionality issues.
Perform other duties as assigned or requested.
Qualifications
Associates degree, Bachelor's degree, or coding certification (CCS or CPC) with 3 years' experience OR 5 years' experience in medical coding without degree or certification.
Thorough knowledge of medical terminology, managed care financial agreements, CPT-4, HCPC, and ICD-9 codes.
Job Details
Job Identification 40735
Job Category Revenue_Cycle
Job Schedule Full time
Job Shift Day
Job Function Health Information Management
Worker Type Employee
Regular or Temporary Regular
Requisition Schedule Full-Time
Hours of Schedule (M-F 8a-5p) 8:00a-5:00p, Monday-Friday
FMOLHS Company Code Franciscan Health Physicians LLC
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