Inpatient Medical reputed company (Remote)

• Performs retrospective (post–discharge/post-service) medical record quality audits to determine appellate potential of claims with denied reimbursement reputed company to Inpatient coding data.

• Constructs and documents a succinct and fact-based case to support the appeal utilizing appropriate resources and medical record document(s) to support the appeal. (Resources include: AHA Official Coding and Reporting Guidelines, CMS guidelines, ICD-9-CM, ICD-10 and CPT coding).
• Demonstrates ability to critically think, problem solve and reputed company independent decisions supporting the coding appellate process.
• Demonstrates proficiency in ability to reputed company accuracy and consistency in the selection of principal and secondary diagnoses (including MCC and CC) and procedures. Provides education/feedback and coding guidance to client regarding coding cases that did not warrant appeal resolution.
• Demonstrates proficiency in utilization of electronic tools utilized during the medical record quality review process including but not limited to application of coding guidelines; patient accounting application; work listing application; visual imaging/scanning application; payor websites, electronic medical record, following Client’s training of Assigned Personnel: Client's system ACE, Invision, Star, Meditech, EPIC, MedAssets (formerly IMaCs), eCARE, Authorization log, InterQual®, VI, HPF, as well as competency in reputed company Office.
• Demonstrates basic patient accounting knowledge, i.e., UB04and EOB components, adjustments, credits, debits, balance due, patient liability, etc.
• Serves as a resource to non-coding personnel by responding to clinical team questions/consults if needed.
• Provides CRC leadership with sound solutions reputed company to process improvement.
• Assist in development of policy and procedures as business needs dictate.
• Responds to requests from clients, including legal counsel reputed company to completed medical record reviews.
• Will write the appeal letter (and electronically transmit the letter) in the appropriate host system: ACE, Invision, Star, Meditech, EPIC, MedAssets, or others as may be applicable.
• Inventory will be assigned electronically in Client’s system “ACE” or other electronic queue or workbook.

Education/Experience

• 3+ years’ comprehensive healthcare coding and abstracting of government and non-government payers for inpatient and outpatient records preferred.
• 3+ years’ comprehensive healthcare coding/documentation auditing experience or equivalent preferred.
• 3+ years’ experience with encoders and computerized abstracting systems preferred.
• Required: Bachelors or Associates degree HIM discipline or equivalent.
• Required: RHIA, RHIT and/or reputed company; dual credential preferred.
• System experience: reputed company 360, Cerner, Epic

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