Coding Compliance Specialist at Northwell Health in Tarrytown, New York
Northwell HealthTarrytown, New York
Coding Compliance Specialist (22.5 hrs./wk., remote)
Job DescriptionThe Coding Compliance Coordinator is responsible for continuous evaluation and assessment of hospital documentation and coding practices.
The position is responsible to provide feedback, education, and training to ensure coding and revenue compliance.
Additionally, accountable to evaluate denials and underpayments and prepares necessary responses or appeals to dispute findings.
1. Patient and Staff Safety:
+ Recognizes the importance of patient/staff safety precautions as it relates to specific department and area of responsibility.
+ Consistently utilizes precautions and follows appropriate procedures to enhance patient/staff safety in daily operations.
+ Identifies and reports any potentially dangerous situations to manager which could cause medical error and / or patient or staff harm . 2. Performance Improvement:
+ Participates in performance / customer service improvement; actively assists in improving performance based on results obtained from customer satisfaction / PI activities.
+ Where appropriate, participates in Performance Improvement activities, including team membership.
Job Responsibilities+ Performs evaluation of claim denials or underpayments related to coding.
Coordinates the appeal process to dispute denials received by RAC, IPRO, Aetna and similar agencies.
Collaborates with Patient Accounting to ensure proper collection of revenues.
+ Conducts regular audits and coordinates ongoing monitoring of coding accuracy and documentation adequacy.
Works closely with all involved parties to ensure coding and revenue integrity.
+ Reviews OIG and OMIG Compliance work plans.
Collaborates with HIM management team to establish audit and training needs for the hospital.
+ Provides feedback and focused educational programs on the results of auditing and monitoring activities to affected staff and physicians.
Makes recommendations to CDI and IT to enhance functionality of electronic medical record to ensure complete documentation. .
+ Develops and coordinates educational and training programs regarding elements of the H.I.M.S. compliance program such as appropriate documentation and accurate coding to all appropriate personnel, including coding staff, physicians, billing personnel and ancillary departments.
+ Ensures that coding consultants and other contracted entities understand, agree and to adhere to the organization's H.I.M.S. compliance program.
+ Requests additional documentation and clarification from physicians and CDI nurses when code assignments are not straightforward or documentation in the record is inadequate, ambiguous, or unclear for coding purposes.
+ Keeps abreast of coding guidelines and reimbursement reporting requirements.
Brings identified concerns to Coding Supervisor or department Director for resolution.
Works collaboratively with HIM team to implement corrective actions.* Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association and adheres to official coding guidelines.* Acts as a liaison with the HIM department, IT and vendors to support efforts to update and maintain technologies used in HIM coding, including Meditech and 3M. Completes required testing to ensure seamless operation or upgrade of applications. Troubleshoots when necessary to address problems at hand.
+ In the absence of the Coding Supervisor, assists with monitoring and completion of daily functions such as DNFB, 3M issues, Patient Accounting issues and IRF PAI submissions.
+ Performs coding functions at a Coder level III as determined by department need.
+ Participates on CDI Committee and provides feedback of issues impacting coding accuracy
+ Actively participates on Chargemaster Committee.
Collaborates with team to ensure completeness and compliance of hospital chargemaster.
Closely evaluates claims to ensure all revenue is captured.
+ Attends HIM committee (with the C.M.O., Physicians, HIMS, Nursing and IT) as needed.
+ Provides monthly updates to the HIM department regarding new trends and updates found in 3M and AHIMA. Provides coding handouts and training when necessary. Provides updates from committee meetings.4 _._ Quality Assurance:
+ Maintains personal professional competency through in-service and meeting attendance.
+ Maintains a safe, orderly working environment; maintains compliance with OSHA regulations.
+ Ensures that HIPAA regulations, Joint Commission standards and PMHC corporate compliance policies are adhered to.
+ Adheres to hospital and department mission statements, policies and procedures.
+ Attends all hospital or departmental in-services.
+ Completes annual HSEP and health assessment as required by Joint Commission.
+ Attends appropriate seminars and conferences as necessary.
6. Performs other duties as assigned and requested. All job requirements listed indicate the minimum level of knowledge, skills and ability deemed necessary to perform the job proficiently. This job description is not to be construed as an exhaustive statement of duties, responsibilities, or requirements.
Employees will be required to perform other job-related instructions given by their supervisor, subject to reasonable accommodations.
+ High school diploma or GED required.
+ Associate's Degree required, Bachelor's degree preferred.
+ Extensive knowledge of ICD-9-CM and CPT coding principles and guidelines.
Some familiarity and training withICD-10+ Must be computer literate; proficiency with MS Office Software (Word/Excel/Power.
Point) and Outlook required.
+ Ability to read, write and communicate in English required.+
+ Five (5) years hospital experience coding various types of records required.
+ Extensive knowledge of reimbursement systems and knowledge of federal, state and payer-specific regulations and policies pertaining to documentation, coding and billing required.+ Licensure,
Registration or Certification:
+ Certified Coding Specialist (CCS), Registered Health Information Technician (RHIT) or Registered Health Information Administrator (RHIA) required.
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