Aurora Health Care
Hospital Coding Quality Specialist - Inpatient
Aurora Health Care, Milwaukee, Wisconsin, United States, 53244
Base pay range
$28.05/hr - $42.10/hr
Major Responsibilities
Reviews coded health information records to evaluate the quality of staff coding and abstracting, verifying accuracy and appropriateness of assigned diagnostic and procedure codes, as well as other abstracted data, such as discharge disposition. Ensure accurate coding for outpatient, day surgery and inpatient records. Verifies all codes and sequencing for claims according to American Hospital Association (AHA) coding guidelines, CPT Assistant, AHA Coding Clinic and national and local coverage decisions.
Works collaboratively with coding leadership per their direction in reviewing records with focused diagnosis and procedure codes, including specific APCs, DRGs and OIG work plan targets to assure compliance in all areas of coding, which may give visibility into documentation that is driving codes.
Works collaboratively with coding leadership to identify focused prospective records that need to be reviewed.
Identifies coder education opportunities, team trends, and consideration of topics to mandate for second level account review before the account is final coded.
Reviews encounters flagged for second level review, including hospital acquired conditions (HACs), complications and other identified records such as core measures or trends as identified by coding leadership. Performs review of coded encounter for appropriate risk‑adjustment, including accurate severity and risk of mortality assignment.
Responsible for coding participation in the Clinical Documentation Improvement and Hospital Coding alignment process. Reviews accounts with mismatched DRG assignment following notification from the Inpatient coder, determines the appropriate DRG based on coding guidelines, and provides follow‑up to the clinical documentation nurse with rationale on final outcome. Recommends educational topics for coders and clinical documentation nurses based on observations from reviewing mismatches.
Participates in hospital coding denial and appeal processes as directed, ensuring timely review and response to any third‑party payer notification of claims where codes are denied. Determines if an appeal will be written based on application of coding guidelines and provider documentation.
Following review of overpayment or underpayment denials, provides appropriate follow‑up to the coding team member and rebilling accounts to ensure appropriate reimbursement. All trends identified are presented to coding leadership timely and logged for historical tracking purposes.
Investigates and resolves all edits or inquiries from the billing office or patient accounts to prevent any delay in claim submission due to open questions related to coding. Identifies any coding issues as they relate to coding practices and clarifies changes in coding guidance or coding educational materials.
Maintains continuing education credits and credentials by staying abreast of current knowledge trends, legislative issues and technology in Health Information Management through internal and external seminars. Identifies opportunities for continuing education for the hospital coding team.
Licensure, Registration, And/or Certification Required
Coding Specialist (CCS) certification issued by the American Health Information Management Association (AHIMA)
Health Information Administrator (RHIA) registration issued by AHIMA
Health Information Technician (RHIT) registration issued by AHIMA
Education Required
Associate’s Degree in Health Information Management or related field.
Experience Required
Typically requires 5 years of experience in hospital coding for a large complex health care system, including hospital coding, denial review and/or coding quality review functions.
Knowledge, Skills & Abilities Required
Demonstrated leadership skills and abilities.
Demonstrates knowledge of National Council on Compensation Insurance, Inc. (NCCI) edits, and local and national coverage decisions.
Expert knowledge and experience in ICD‑10‑CM/PCS, CPT coding systems, G‑codes, HCPCS codes, Current Procedural Terminology (CPT), modifiers, and Ambulatory Patient Categories (APC), MS‑DRGs (Diagnosis related groups).
Advanced knowledge in Microsoft Applications, including but not limited to Excel, Word, PowerPoint, Teams.
Advanced knowledge and understanding of anatomy and physiology, medical terminology, pathophysiology (disease process, surgical terminology and pharmacology).
Advanced knowledge of pharmacology indications for drug usage and related adverse reactions.
Expert knowledge of coding workflow and optimization of technology, including navigation in the electronic health information record and in health information management and billing systems.
Excellent communication and reading comprehension skills.
Demonstrated analytical aptitude, with a high attention to detail and accuracy.
Ability to take initiative and work collaboratively with others.
Experience with remote workforce operations required.
Strong sense of ethics.
Physical Requirements And Working Conditions
Exposed to a normal office environment.
Must be able to sit for extended periods of time.
Must be able to continuously concentrate.
Position may require travel to other sites; may be exposed to road and weather hazards.
Operates all equipment necessary to perform the job.
This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.
#REMOTE
Seniority level Not Applicable
Employment type Full‑time
Job function Other
Industries Hospitals and Health Care
Referrals increase your chances of interviewing at Aurora Health Care by 2x
#J-18808-Ljbffr
Major Responsibilities
Reviews coded health information records to evaluate the quality of staff coding and abstracting, verifying accuracy and appropriateness of assigned diagnostic and procedure codes, as well as other abstracted data, such as discharge disposition. Ensure accurate coding for outpatient, day surgery and inpatient records. Verifies all codes and sequencing for claims according to American Hospital Association (AHA) coding guidelines, CPT Assistant, AHA Coding Clinic and national and local coverage decisions.
Works collaboratively with coding leadership per their direction in reviewing records with focused diagnosis and procedure codes, including specific APCs, DRGs and OIG work plan targets to assure compliance in all areas of coding, which may give visibility into documentation that is driving codes.
Works collaboratively with coding leadership to identify focused prospective records that need to be reviewed.
Identifies coder education opportunities, team trends, and consideration of topics to mandate for second level account review before the account is final coded.
Reviews encounters flagged for second level review, including hospital acquired conditions (HACs), complications and other identified records such as core measures or trends as identified by coding leadership. Performs review of coded encounter for appropriate risk‑adjustment, including accurate severity and risk of mortality assignment.
Responsible for coding participation in the Clinical Documentation Improvement and Hospital Coding alignment process. Reviews accounts with mismatched DRG assignment following notification from the Inpatient coder, determines the appropriate DRG based on coding guidelines, and provides follow‑up to the clinical documentation nurse with rationale on final outcome. Recommends educational topics for coders and clinical documentation nurses based on observations from reviewing mismatches.
Participates in hospital coding denial and appeal processes as directed, ensuring timely review and response to any third‑party payer notification of claims where codes are denied. Determines if an appeal will be written based on application of coding guidelines and provider documentation.
Following review of overpayment or underpayment denials, provides appropriate follow‑up to the coding team member and rebilling accounts to ensure appropriate reimbursement. All trends identified are presented to coding leadership timely and logged for historical tracking purposes.
Investigates and resolves all edits or inquiries from the billing office or patient accounts to prevent any delay in claim submission due to open questions related to coding. Identifies any coding issues as they relate to coding practices and clarifies changes in coding guidance or coding educational materials.
Maintains continuing education credits and credentials by staying abreast of current knowledge trends, legislative issues and technology in Health Information Management through internal and external seminars. Identifies opportunities for continuing education for the hospital coding team.
Licensure, Registration, And/or Certification Required
Coding Specialist (CCS) certification issued by the American Health Information Management Association (AHIMA)
Health Information Administrator (RHIA) registration issued by AHIMA
Health Information Technician (RHIT) registration issued by AHIMA
Education Required
Associate’s Degree in Health Information Management or related field.
Experience Required
Typically requires 5 years of experience in hospital coding for a large complex health care system, including hospital coding, denial review and/or coding quality review functions.
Knowledge, Skills & Abilities Required
Demonstrated leadership skills and abilities.
Demonstrates knowledge of National Council on Compensation Insurance, Inc. (NCCI) edits, and local and national coverage decisions.
Expert knowledge and experience in ICD‑10‑CM/PCS, CPT coding systems, G‑codes, HCPCS codes, Current Procedural Terminology (CPT), modifiers, and Ambulatory Patient Categories (APC), MS‑DRGs (Diagnosis related groups).
Advanced knowledge in Microsoft Applications, including but not limited to Excel, Word, PowerPoint, Teams.
Advanced knowledge and understanding of anatomy and physiology, medical terminology, pathophysiology (disease process, surgical terminology and pharmacology).
Advanced knowledge of pharmacology indications for drug usage and related adverse reactions.
Expert knowledge of coding workflow and optimization of technology, including navigation in the electronic health information record and in health information management and billing systems.
Excellent communication and reading comprehension skills.
Demonstrated analytical aptitude, with a high attention to detail and accuracy.
Ability to take initiative and work collaboratively with others.
Experience with remote workforce operations required.
Strong sense of ethics.
Physical Requirements And Working Conditions
Exposed to a normal office environment.
Must be able to sit for extended periods of time.
Must be able to continuously concentrate.
Position may require travel to other sites; may be exposed to road and weather hazards.
Operates all equipment necessary to perform the job.
This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.
#REMOTE
Seniority level Not Applicable
Employment type Full‑time
Job function Other
Industries Hospitals and Health Care
Referrals increase your chances of interviewing at Aurora Health Care by 2x
#J-18808-Ljbffr