Grace Federal Solutions LLC
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Inpatient Compliance Specialist - HIM Coding
at Grace Federal Solutions LLC
Evaluate, analyze and maintain an accurate and meaningful Coding database for the hospital services, reflective of patient mix and resource use through monitoring of coding compliance in accordance with the Office of Inspector General's Work Plan, education and internal audits.
Monitor data quality and optimal reimbursement to the hospital by performing prospective quality reviews for accurate coding and sequencing of diagnoses and procedures for inpatient services using Center for Medicare and Medicaid coding guidelines, standards and regulations.
Conduct routine internal audits of coded data and physician documentation, report the results and recommend corrective action as needed.
Present timely, relevant educational programs to coding staff regarding coding updates, documentation and prospective payment system requirements. Participate in training of the coders and evaluate the effectiveness of the training.
Interpret guidelines, applicable laws and regulations concerning hospital coding published in AHA Coding Clinic, AMA CPT Assistant, Federal Register, Medicare Bulletin, etc. Develop and maintain specific coding guidelines for inpatient and outpatient coding. Research problem areas and develop training material and coding aids for the coders. Maintain/update the coding compliance manual for the hospital.
Respond promptly to external audits. Identify coding risk areas for the hospital technical charges, conduct focused reviews, report the results, and implement corrective action as needed.
Serve as a resource to the hospital on coding and documentation-related issues. Educate physicians and other health care professionals regarding documentation requirements for accurate coding and reimbursement. Educate Administration, Financial Management, Patient Resource Management, Revenue Managers, etc. regarding DRGs/APCs/APR-DRGs and the reimbursement methodologies.
Perform other related duties incidental to the work described herein including special projects
Work requires organization, analytical and communication skills generally acquired through the completion of a Bachelor's degree program.
Four years of administrative experience to acquire competence in applying compliance, coding and auditing principles as they relate to insurance billing, collections, consulting, and other revenue cycle related functions.
For technical coding, two of the four years of experience with DRG's and APR-DRG's is required. Experience in formal teaching of coding is highly preferred.
RHIA or RHIT or CCS is required. For professional coding, specialty coding experience in surgical or E/M coding preferred. CPC or CCS or RHIT or RHIA or CPMA is required.