Aurora Health Care
Hospital Coding Quality Specialist - Outpatient
Aurora Health Care, Milwaukee, Wisconsin, United States, 53244
Hospital Coding Quality Specialist - REMOTE
Apply for the Hospital Coding Quality Specialist - REMOTE role at Aurora Health Care. Aurora Health Care provides a competitive pay range. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.
Base Pay Range $28.05/hr - $42.10/hr
Responsibilities
Complete hospital coding accuracy reviews to assist coding leadership in carrying out the department’s compliance plan and ensuring accurate coding of documentation and appropriate reimbursement.
Review coded health information records to evaluate the quality of staff coding and abstracting, verify accuracy of diagnostic and procedure codes, and other abstracted data such as discharge disposition; ensure accurate coding for outpatient, day surgery and inpatient records; verify all codes and sequencing for claims according to AHA coding guidelines, CPT Assistant, AHA Coding Clinic and national/local coverage decisions.
Work collaboratively with coding leadership to review records with focused diagnosis and procedure codes, including specific APCs, DRGs and OIG work‑plan targets, to assure compliance in all areas of coding.
Identify focused prospective records that need to be reviewed.
Identify coder education opportunities, team trends, and consideration of topics to mandate for second‑level account review before the account is final coded.
Review encounters flagged for second‑level review, such as hospital‑acquired conditions, complications and other identified core measures or trends; perform risk‑adjustment reviews for accurate severity and risk‑of‑mortality assignment.
Participate in the Clinical Documentation Improvement and Hospital Coding alignment process; review accounts with mismatched DRG assignment following notification from the inpatient coder; determine the appropriate DRG; follow up with the clinical documentation nurse; recommend educational topics based on mismatches.
Participate in hospital coding denial and appeal processes; ensure timely review and response to third‑party payer notifications; determine if an appeal will be written based on coding guidelines and provider documentation.
After review of overpayment or underpayment denials, provide follow‑up to the coding team, re‑bill accounts as needed, and present trends to coding leadership in a timely manner.
Investigate and resolve all edits or inquiries from the billing office or patient accounts to prevent claim‑submission delays; clarify changes in coding guidance or educational materials.
Maintain continuing education credits and credentials, stay abreast of current knowledge trends, legislative issues, and technology in Health Information Management, and identify opportunities for the coding team.
Scheduled Hours
Monday through Friday: First Shift
This is a REMOTE opportunity.
Licenses & Certifications
Coding Specialist (CCS) certification issued by the American Health Information Management Association (AHIMA)
Health Information Administrator (RHIA) registration issued by the American Health Information Management Association (AHIMA)
Health Information Technician (RHIT) registration issued by the American Health Information Management Association (AHIMA)
Degrees
Associate’s Degree in Health Information Management or related field.
Required Functional Experience Typically requires 5 years of experience in hospital coding for a large complex health care system, which includes hospital coding, denial review and/or coding quality review functions.
Knowledge, Skills & Abilities
Demonstrated leadership skills and abilities.
Knowledge of National Council on Compensation Insurance (NCCI) edits and local/national coverage decisions.
Expert knowledge of ICD‑10‑CM/PCS, CPT, G‑codes, HCPCS, modifiers, APC, MS‑DRGs.
Advanced Microsoft Applications (Excel, Word, PowerPoint, Teams) proficiency.
Advanced knowledge of anatomy, physiology, medical terminology, pathophysiology, surgical terminology and pharmacology.
Advanced pharmacology knowledge of drug indications and adverse reactions.
Expertise in coding workflow and technology optimization, including navigation of electronic health records and billing systems.
Excellent communication and reading comprehension skills.
Analytical aptitude with high attention to detail and accuracy.
Initiative and ability to collaborate with others.
Experience with remote workforce operations.
Strong sense of ethics.
Seniority Level Not Applicable
Employment Type Full‑time
Job Function Other
#J-18808-Ljbffr
Base Pay Range $28.05/hr - $42.10/hr
Responsibilities
Complete hospital coding accuracy reviews to assist coding leadership in carrying out the department’s compliance plan and ensuring accurate coding of documentation and appropriate reimbursement.
Review coded health information records to evaluate the quality of staff coding and abstracting, verify accuracy of diagnostic and procedure codes, and other abstracted data such as discharge disposition; ensure accurate coding for outpatient, day surgery and inpatient records; verify all codes and sequencing for claims according to AHA coding guidelines, CPT Assistant, AHA Coding Clinic and national/local coverage decisions.
Work collaboratively with coding leadership to review records with focused diagnosis and procedure codes, including specific APCs, DRGs and OIG work‑plan targets, to assure compliance in all areas of coding.
Identify focused prospective records that need to be reviewed.
Identify coder education opportunities, team trends, and consideration of topics to mandate for second‑level account review before the account is final coded.
Review encounters flagged for second‑level review, such as hospital‑acquired conditions, complications and other identified core measures or trends; perform risk‑adjustment reviews for accurate severity and risk‑of‑mortality assignment.
Participate in the Clinical Documentation Improvement and Hospital Coding alignment process; review accounts with mismatched DRG assignment following notification from the inpatient coder; determine the appropriate DRG; follow up with the clinical documentation nurse; recommend educational topics based on mismatches.
Participate in hospital coding denial and appeal processes; ensure timely review and response to third‑party payer notifications; determine if an appeal will be written based on coding guidelines and provider documentation.
After review of overpayment or underpayment denials, provide follow‑up to the coding team, re‑bill accounts as needed, and present trends to coding leadership in a timely manner.
Investigate and resolve all edits or inquiries from the billing office or patient accounts to prevent claim‑submission delays; clarify changes in coding guidance or educational materials.
Maintain continuing education credits and credentials, stay abreast of current knowledge trends, legislative issues, and technology in Health Information Management, and identify opportunities for the coding team.
Scheduled Hours
Monday through Friday: First Shift
This is a REMOTE opportunity.
Licenses & Certifications
Coding Specialist (CCS) certification issued by the American Health Information Management Association (AHIMA)
Health Information Administrator (RHIA) registration issued by the American Health Information Management Association (AHIMA)
Health Information Technician (RHIT) registration issued by the American Health Information Management Association (AHIMA)
Degrees
Associate’s Degree in Health Information Management or related field.
Required Functional Experience Typically requires 5 years of experience in hospital coding for a large complex health care system, which includes hospital coding, denial review and/or coding quality review functions.
Knowledge, Skills & Abilities
Demonstrated leadership skills and abilities.
Knowledge of National Council on Compensation Insurance (NCCI) edits and local/national coverage decisions.
Expert knowledge of ICD‑10‑CM/PCS, CPT, G‑codes, HCPCS, modifiers, APC, MS‑DRGs.
Advanced Microsoft Applications (Excel, Word, PowerPoint, Teams) proficiency.
Advanced knowledge of anatomy, physiology, medical terminology, pathophysiology, surgical terminology and pharmacology.
Advanced pharmacology knowledge of drug indications and adverse reactions.
Expertise in coding workflow and technology optimization, including navigation of electronic health records and billing systems.
Excellent communication and reading comprehension skills.
Analytical aptitude with high attention to detail and accuracy.
Initiative and ability to collaborate with others.
Experience with remote workforce operations.
Strong sense of ethics.
Seniority Level Not Applicable
Employment Type Full‑time
Job Function Other
#J-18808-Ljbffr