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Role Description

As a part of our Coding Quality team, our coding editors play an integral role in reviewing coding quality alerts and/or billing edits for hospital, outpatient, and ambulatory encounters. This team will also review coding denials and evaluate areas of improvement throughout the revenue cycle process.

• Verifying accuracy of assigned CPT codes for complex and/or error-prone procedures.
• Verifying diagnosis coding accuracy for complex and/or error-prone encounters.
• Reviewing charge and procedure mismatches.
• Reviewing codes with revenue integrity edits for NCD/LCD coverage.
• Reviewing invalid codes, code conflicts, and missing modifiers.
• Working with other teams in billing, revenue integrity, coding operations, coding compliance, and other revenue cycle counterparts.
• Combining codes for payment window encounters.
• Assisting with resolution of accounts with HIM/Coding unbilled hold reasons preventing final billing.
• Validating certain discharge dispositions.
• Assigning appropriate diagnosis and procedure codes for inpatient and/or outpatient episodes of care.
• Assisting other coders by training and advising on coding and abstracting.
• Assisting in resolving billing edits that are holding patient claims from billing.
• Identifying ways to improve work processes and improve customer satisfaction.
• Serving as a liaison between management, coders, physicians, nurses, medical staff, Patient Financial Services, and hospital employees.
• Maintaining a positive working relationship to ensure that medical record information is documented and coded according to established conventions.
• Assisting in the identification and reporting of potential quality issues.
• Ensuring unbilled items are addressed properly and timely.
• Identifying and reviewing charging, coding, and clinical documentation issues.

Qualifications

• Must have successfully completed an approved coding program OR be a graduate of a Health Information Management program.
• Must have five years of coding experience in an acute care hospital environment.
• May have an equivalent combination of education and experience in lieu of specific education and/or experience as stated above.
• Must be certified through the American Health Information Management Association or the American Association of Procedural Coders.

Requirements

• Must be able to demonstrate advanced knowledge of coding and abstracting skills.
• Applicants must pass applicable coding test with an 85% or above prior to placement into position.
• Must be able to demonstrate knowledge of reimbursement (Medicare and Medicaid) principles.
• Must have extensive knowledge of medical terminology, the human disease process, anatomy, and physiology.
• Must be able to demonstrate good organizational and leadership skills.
• Must be able to communicate effectively, both orally and in writing.
• Must be able to demonstrate knowledge of computer software applications including MS Office.

Benefits

• This position is 100% Virtual.
• Virtual employees must comply with all Parkland policies and procedures governing the use of Parkland information resources.
• Virtual employees must maintain all equipment lent by Parkland for performing the agreed-upon job duties in good working condition.