Community Health Systems Corporate Coding Denials Auditor in Franklin, Tennessee

Description:

Community Health Systems Professional Services Corporation seeks a Corporate Coding Denials Auditor for its Franklin, TN, headquarters Health Informatics & Information Management team.

SUMMARY:

Performs inpatient coding DRG denial audits of RAC and non-RAC payer accounts, for the HIIM Department at the Corporate office. Reviews patient records for accuracy in ICD-9-CM coding, ICD-10-CM/PCS, DRG assignment, present on admission indicators (POA), discharge disposition and any other pertinent data needed to capture coding accuracy. Provides audit feedback via the auditing process to pertinent parties, i.e. HIM Director, Regional Coding Manager, etc.. Assists in preparation of the monthly and quarterly denials audit reports. Applied knowledge of medical terminology, pathophysiology, and pharmacology. Demonstrates tested data quality and integrity skills.

ESSENTIAL DUTIES:

  • Performs inpatient coding audits using ICD-9-CM, ICD-10-CM/PCS, DRG validation (3Mcoding software) utilizing appropriate coding references for CHS hospitals via scanned, electronic and hybrid medical records.

  • Will utilize hospital abstracting system for coding validation when applicable.

  • Prepares preliminary results for review by the requesting party.

  • Reviews DRG change disagreements with the Director of Coding Audits & Denials Management.

  • Assists in preparation of the final quarterly audit reports for Division VP s, AVP s, facility CEO s, CFO s, Regional HIM Director s, VP of HIIM.

  • Provides coder education via email and phone on all audits and uses applicable coding references.

  • Maintains productivity levels set forth by the HIIM Department and interdepartmental policy while maintaining a 97 accuracy rate by third party auditors.

  • Consults with Director of Coding Audits & Denials Management during any audit discrepancies.

  • Attends coding workshops as necessary to maintain coding credentials.

  • Keeps abreast of regulatory changes affecting coding rules and regulations.

  • Maintains proficiency in the Official Coding Guidelines for coding and reporting and the AHACoding Clinics .

  • Other duties as assigned by Director of Coding Audits & Denials Management

Qualifications

EDUCATION AND EXPERIENCE:

A minimum of a high school diploma. American HealthInformation Management Association (AHIMA) credential – Certified Coding Specialist (CCS), Registered Health Information Administrator (RHIA), or Registered Health Information Technician (RHIT) required. American Academy of Professional Coders (AAPC) – Certified Professional Coder (CPC) or Certified Professional Medical Auditor (CPMA). A minimum of three –five years on going inpatient coding and abstracting experience in ICD-9-CM and DRGs. A minimum of two years auditing experience. Proficient in Excel, M/S Word and general PC applications.

JOB SKILLS:

  • Thorough knowledge of the related inpatient prospective payment systems (IPPS)

  • Experience in working DRG coding denials and writing appeal letters to government and non-government payers

  • Experience preserving coding integrity based on Coding Guidelines, Coding Clinic and appropriate coding references and resources

  • Broad knowledge of pharmacology indications for drug usage and related adverse reactions

  • Knowledge of anatomy, physiology and medical terminology

  • Understanding of coding practices and official guidelines

  • Experience with PC, mainframe applications, and encoding systems

  • Auditing skills for coding quality and compliance

  • Strong process management skills

LANGUAGE SKILLS:

English is required for both verbal and written communication.

CERTIFICATES, LICENSES, REGISTRATIONS:

Must be CCS, RHIA, RHIT, CPC or CPMA

Must have valid driver s license.

PHYSICAL DEMANDS:

Must be able to sit for long periods of time and work on a computer. Must be able to work in a quiet home office setting utilizing email and phone to communicate with coworkers.

WORK ENVIRONMENT:

Remote

Job: Health Information

Organization: CHS Corporate

Location: TN-Franklin

Requisition ID: 1838700