POSITION PURPOSE
Responsible for performing and managing the denials management process (i.e., audit of Medicare denials) as part of the Recovery Audit Contractors (RAC) Audit. Provides system-wide coding quality reviews and assesses audit denials; identifies audit appeal strategies and develops focused coder education and auditing programs to improve skills and compliance; and determines documentation improvement opportunities in order to reduce and/or eliminate future reviews. Provides a high-level of technical competency and serves as a subject matter expert regarding documentation, coding, billing, reimbursement and compliance management. Responsible for special compliance related projects, develops and delivers educational programs, informational materials, work products and tools to departments in order to optimize data quality and appropriate payment methods, improve skills, establish improved physician documentation initiatives, respond to the perceived needs of coding quality reviews, and support the development and implementation of best practices, guidelines and policies to ensure compliance with regulations.
MINIMUM QUALIFICATIONS
Bachelor's degree or an equivalent combination of education and experience. Minimum of three (3) to six (6) years experience in a health care setting. Must possess at least one (1) of the following licenses/certifications: RHIT, RHIS, RN, CPC and CCS or professional certification in another healthcare field. Three (3) to six (6) years of progressive experience in various hospital functions, such as coding, billing and reimbursement. Must have a proficient knowledge of Medicare, Medicaid and other third party payer documentation, coding and billing regulations. Working knowledge of Medicare Conditions of Participation required. Must be able to demonstrate knowledge of both ICD-9-CM and CPT-4 coding procedures. Must possess computer skills, especially with Microsoft Word, Access and Excel applications. Must be able to use Internet and other resource applications for research purposes and to provide documentations that supports regulations quoted in audits. Must possess excellent organizational and planning skills, including the ability to prioritize and perform multiple tasks both accurately and simultaneously. Ability to work with high workload volumes, meet established deadlines and work in a face paced work environment. Must possess strong written and verbal communication skills in order to communicate in clear, concise terms to management at all levels, including the ability to articulate complex regulatory information in layman's terms. Knowledge of medical terminology and coding. Strong interpersonal skills.
