IP Coder/Auditor in Allentown, Pennsylvania at Good Shepherd Rehabilitation Network

Good Shepherd Rehabilitation Network
Allentown, Pennsylvania, 18103, United States
Posted on

Job Description

  • JOB SUMMARY
    • Reviews patient records, assigns diagnostic and procedural codes, performs related functions and participates in Performance Improvement activities.
  • ESSENTIAL FUNCTIONS
    • DIAGNOSTIC CODING OF ALL MEDICAL RECORDS REPORTED ON PATIENT BILLS
      • By coding all diagnoses, treatments, and procedures according to the appropriate classification system for the category of patient encounter
      • By accurately coding all inpatient records in accordance with ICD-10 CM/PCS coding rules and guidelines in a timely manner with a 95% accuracy rate
      • By following approved coding conventions, assigns diagnostic and procedural codes to inpatient records
      • Reviews AHA Coding Clinic and demonstrates the ability to accurately apply new coding guidelines.
      • Researches new diagnostic and procedure codes as required performing the coding function.
      • Informs coding supervisor of trends and opportunities for improvement in clinical documentation.
      • Works collaboratively with other coders.
      • Adheres to the American Health Information Management’s Code of Ethics.
    • LOCATES MEDICAL RECORDS THAT REQUIRE CODE ASSIGNMENT
      • By searching master patient index; identifying location of existing patient records and obtaining the documentation required for code assignment.
    • MAINTAINS MEDICAL RECORDS OPERATIONS
      • By following policies and procedures; reporting needed change
    • RESOLVES MEDICAL RECORD DISCREPANCIES
      • By acting as a resource to other staff on coding issues
      • By assisting the physicians with documentation improvement via the diagnostic query form
      • By collecting and analyzing information
    • MAINTAINS HISTORICAL REFERENCE
      • By abstraction and data entry of all inpatient records into the Good Shepherd Hospital computer system for clinical and financial purposes
      • By abstracting and coding clinical data, such as diseases, procedures, using standard classification systems.
      • By providing DRG/CMG forecasting information to Nurse Liaison as needed.
      • By accurately assigning the correct principal diagnosis on LTCH and rehab accounts.
      • By performing weekly/bi-weekly concurrent chart reviews for any potential DRG/CMG changes during the patient stay.
      • By coding all discharged charts timely and accurately
    • PROVIDES MEDICAL RECORD INFORMATION
      • By providing codes for billing and answers questions from hospital staff
      • By assisting physicians and other direct patient care professionals in questions regarding level of detail for diagnostic entries, according to the organization’s guidelines
    • MAINTAINS THE STABILITY AND REPUTATION OF THE HOSPITAL
      • By complying with legal requirements.
    • SUPPORTS REGULATORY AUDIT PROCESSES (E.G. RCD, RAC, ADR, ETC)

    • PROVIDE SUPPORT TO REVIEW CHOICE DEMONSTRATION (RCD) AUDITOR COORDINATOR AS NEEDED AND BIWEEKLY WEEKEND/VACATION COVERAGE

    • Completes Medical Record Audits
      • Accesses and runs automated audit tool via facility’s EMR to determine elements out of compliance via standard work process.
      • Reviews documents for completion, guided by CMS rules and regulations.
    • COMMUNICATES AUDIT RESULTS
      • Communicates document compliance to appropriate providers and extenders of documentation status for compliance and improvement.
      • Upon record audit completion, sends records to manager to second level review and approval in a timely manner.
      • Communicates daily with Director of Revenue Compliance regarding audit progress, issues, other departmental work timelines, priorities, etc.
      • Communicates effectively with colleague stakeholders to inform them of potential issues identified and receive updated documentation that meets CMS standards.
    • SUBMITS/REPORTS/AUDIT RESULTS TO/FROM CMS
      • Prepares documents for initial upload and resubmissions to CMS via Novitasphere.
      • Manages daily communication of results and status with CMS and RCD team.
    • PROVIDES ADMINISTRATIVE SUPPORT
      • Manages and updates audit results via smartsheet tool.
      • When issues are identified, problem solves the reason and initiates solutions (communicating to providers, escalating to Director of Revenue Compliance, etc.) to a goal of 100% compliance of medical record files.
  • QUALIFICATIONS:
    • To 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.
      • Education
        • High School Diploma required
        • Completion of the AHIMA independent study program preferred
      • Work Experience
        • 2-4 years of inpatient coding experience utilizing ICD-9-CM and/or ICD-10-CM/PCS required
      • Licenses / Certifications
        • RHIA, RHIT, CCS, CPC, active member in AHIMA preferred

Explore Related Opportunities

Medical Records Specialists jobs near me in PennsylvaniaJobs near me in PennsylvaniaMedical Records Specialists jobs

Job Location

Allentown, Pennsylvania, 18103, United States

Frequently asked questions about this position

Apply For This Position

Apply Now