Coding Quality Auditor - Remote
As a part of the Tenet and Catholic Health Initiatives family, Conifer Health brings 30 years of healthcare industry expertise to clients in more than 135 local regions nationwide.
We help our clients strengthen their financial and clinical performance, serve their communities and succeed at the business of healthcare.
Conifer Health helps organizations transition from volume to value-based care, enhance the consumer and patient healthcare experience and improve quality, cost and access to healthcare.
Are you ready to be part of our solutions? Welcome to the company that gives you the resources and incentives to redefine healthcare services, with a competitive benefits package and leadership to take your career to the next step!Job SummaryConducts data quality audits of inpatient admissions and outpatient encounters to validate coding assignment is in compliance with the official coding guidelines as supported by clinical documentation in health record.
Validates abstracted data elements that are integral to appropriate payment methodology.
Essential Duties And ResponsibilitiesInclude the following.
Others may be assigned.
Consulting:
Consults facility leaders and staff on best practices, methodology, and tools for accurately coding.
Chart Analysis IP, OP Coding Data auditing and validation:
Reviews medical records for the determination of accurate assignment of all documented diagnoses and procedures.
Adheres to Standards of Ethical Coding (AHIMA).
Reviews medical records for the determination of accurate assignment of all documented diagnoses and procedures.
Reviews claim to validate abstracted data including but limited to discharge disposition which impacts facility reimbursement and/or MS-DRG assignment.
Adheres to Standards of Ethical Coding (AHIMA).
Reviews medical records to determine accurate required abstracting elements (facility/client/payer specific elements) including appropriate discharge dispositionIP, OP Coding:
Reviews medical records for the determination of accurate assignment of all documented ICD-9-CM codes for diagnoses and procedures.
Abstracts accurate required data elements (facility/client specific elements) including appropriate discharge disposition.
Coding:
Uses discretion and specialized coding training and experience to accurately assign ICD-9, CPT-4 codes to patient medical records.
Abstracting:
Reviews medical records to determine accurate required abstracting elements (client specific elements) including appropriate discharge disposition.
Coding Quality:
Demonstrates ability to achieve accuracy and consistency in the selection of principal and secondary diagnoses (including MCC & CC) and procedures.
Demonstrates ability to achieve accuracy and consistency in abstracting elements defined by SOW.
CDI:
Identifies and communicates documentation improvement opportunities and coding issues (lacking documentation, physician queries, etc.
) to appropriate personnel for follow-up and resolution.
Professional Development:
Stays current with AHA Official Coding and Reporting Guidelines, CMS and other agency directives for ICD-9-CM and CPT coding.
Attends mandatory coding seminars on annual basis (IPPS and OPPS, ICD-9-CM and CPT updates) for inpatient and outpatient coding.
Quarterly review of AHA Coding Clinic.
Attends Quarterly Coding Updates and all coding conference calls.
QualificationsConifer requires its candidates and contractors, as applicable and as permitted by law, to obtain and provide confirmation of all required vaccinations and screenings prior to the start of employment activity.
This may include, but is not limited to, the COVID-19 vaccination, influenza vaccination, and/or any future required vaccines and screenings.
Knowledge, Skills, AbilitiesTo perform this job successfully, an individual must be able to perform each essential duty satisfactorily.
The requirements listed below are representative of the knowledge, skill and/or ability required.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Ability to consistently code at 95% accuracy and quality while maintaining client specified production standardsMust successfully pass coding testKnowledge of medical terminology, ICD-9-CM and CPT-4 codesMust be detail oriented and have the ability to work independently Computer knowledge of MS OfficeMust display excellent interpersonal skillsThe coder should demonstrate initiative and discipline in time management and assignment completion The coder must be able to work in a virtual setting under minimal supervisionIntermediate knowledge of disease pathophysiology and drug utilizationIntermediate knowledge of MSDRG classification and reimbursement structuresIntermediate knowledge of APC, OCE, NCCI classification and reimbursement structuresEducation / ExperienceAssociates degree in relevant field preferred or combination of equivalent of education and experienceThree years coding experience including hospital and consulting backgroundCERTIFICATES, LICENSES, REGISTRATIONSAHIMA Credentials, and or AAPCPHYSICAL DEMANDS The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Duties may require bending, twisting and lifting of materials up to 25 lbs.
Duties may require driving an automobile to off- site locations.
Duties may require travel via, plane, care, train, bus, and taxi-cab.
Ability to sit for extended periods of time.
Must be able to efficiently use computer keyboard and mouse to perform coding assignments.
WORK ENVIRONMENT The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Floats between clients as requested.
Capacity to work independently in a virtual office setting or at hospital setting if required to travel for assignment.
OtherRegular travel may be requiredJob:
Conifer Health SolutionsPrimary Location:
Frisco, TexasJob Type:
Full-timeShift Type:
Daysby Jobble.
Estimated Salary: $20 to $28 per hour based on qualifications.
We help our clients strengthen their financial and clinical performance, serve their communities and succeed at the business of healthcare.
Conifer Health helps organizations transition from volume to value-based care, enhance the consumer and patient healthcare experience and improve quality, cost and access to healthcare.
Are you ready to be part of our solutions? Welcome to the company that gives you the resources and incentives to redefine healthcare services, with a competitive benefits package and leadership to take your career to the next step!Job SummaryConducts data quality audits of inpatient admissions and outpatient encounters to validate coding assignment is in compliance with the official coding guidelines as supported by clinical documentation in health record.
Validates abstracted data elements that are integral to appropriate payment methodology.
Essential Duties And ResponsibilitiesInclude the following.
Others may be assigned.
Consulting:
Consults facility leaders and staff on best practices, methodology, and tools for accurately coding.
Chart Analysis IP, OP Coding Data auditing and validation:
Reviews medical records for the determination of accurate assignment of all documented diagnoses and procedures.
Adheres to Standards of Ethical Coding (AHIMA).
Reviews medical records for the determination of accurate assignment of all documented diagnoses and procedures.
Reviews claim to validate abstracted data including but limited to discharge disposition which impacts facility reimbursement and/or MS-DRG assignment.
Adheres to Standards of Ethical Coding (AHIMA).
Reviews medical records to determine accurate required abstracting elements (facility/client/payer specific elements) including appropriate discharge dispositionIP, OP Coding:
Reviews medical records for the determination of accurate assignment of all documented ICD-9-CM codes for diagnoses and procedures.
Abstracts accurate required data elements (facility/client specific elements) including appropriate discharge disposition.
Coding:
Uses discretion and specialized coding training and experience to accurately assign ICD-9, CPT-4 codes to patient medical records.
Abstracting:
Reviews medical records to determine accurate required abstracting elements (client specific elements) including appropriate discharge disposition.
Coding Quality:
Demonstrates ability to achieve accuracy and consistency in the selection of principal and secondary diagnoses (including MCC & CC) and procedures.
Demonstrates ability to achieve accuracy and consistency in abstracting elements defined by SOW.
CDI:
Identifies and communicates documentation improvement opportunities and coding issues (lacking documentation, physician queries, etc.
) to appropriate personnel for follow-up and resolution.
Professional Development:
Stays current with AHA Official Coding and Reporting Guidelines, CMS and other agency directives for ICD-9-CM and CPT coding.
Attends mandatory coding seminars on annual basis (IPPS and OPPS, ICD-9-CM and CPT updates) for inpatient and outpatient coding.
Quarterly review of AHA Coding Clinic.
Attends Quarterly Coding Updates and all coding conference calls.
QualificationsConifer requires its candidates and contractors, as applicable and as permitted by law, to obtain and provide confirmation of all required vaccinations and screenings prior to the start of employment activity.
This may include, but is not limited to, the COVID-19 vaccination, influenza vaccination, and/or any future required vaccines and screenings.
Knowledge, Skills, AbilitiesTo perform this job successfully, an individual must be able to perform each essential duty satisfactorily.
The requirements listed below are representative of the knowledge, skill and/or ability required.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Ability to consistently code at 95% accuracy and quality while maintaining client specified production standardsMust successfully pass coding testKnowledge of medical terminology, ICD-9-CM and CPT-4 codesMust be detail oriented and have the ability to work independently Computer knowledge of MS OfficeMust display excellent interpersonal skillsThe coder should demonstrate initiative and discipline in time management and assignment completion The coder must be able to work in a virtual setting under minimal supervisionIntermediate knowledge of disease pathophysiology and drug utilizationIntermediate knowledge of MSDRG classification and reimbursement structuresIntermediate knowledge of APC, OCE, NCCI classification and reimbursement structuresEducation / ExperienceAssociates degree in relevant field preferred or combination of equivalent of education and experienceThree years coding experience including hospital and consulting backgroundCERTIFICATES, LICENSES, REGISTRATIONSAHIMA Credentials, and or AAPCPHYSICAL DEMANDS The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Duties may require bending, twisting and lifting of materials up to 25 lbs.
Duties may require driving an automobile to off- site locations.
Duties may require travel via, plane, care, train, bus, and taxi-cab.
Ability to sit for extended periods of time.
Must be able to efficiently use computer keyboard and mouse to perform coding assignments.
WORK ENVIRONMENT The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Floats between clients as requested.
Capacity to work independently in a virtual office setting or at hospital setting if required to travel for assignment.
OtherRegular travel may be requiredJob:
Conifer Health SolutionsPrimary Location:
Frisco, TexasJob Type:
Full-timeShift Type:
Daysby Jobble.
Estimated Salary: $20 to $28 per hour based on qualifications.
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