Coder Reviewer - Inpatient Second Level- 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 SUMMARY 

Support and provide coding and compliance training to clinical personnel, billing, and/or other client staff. Establish effective communication with clinical staff, and/or hospital staff to address documentation, coding, and reimbursement issues. Use knowledge of coding and compliance guidelines to identify potential billing / reimbursement issues. Participate in special audits and system administration as necessary. Use knowledge of coding and compliance guidelines to identify potential coding/quality/ billing / reimbursement issues as a second level reviewer. Assesses accuracy, quality, and compliance of diagnosis, procedure, POA, DRG, and discharge disposition assignment on Inpatient accounts. Apply rationale from Coding Guidelines, Coding Clinics, Coding Handbook, and other resources to support coding recommendations on Inpatient accounts. Identify review workflow issues and manage workload.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Include the following. Others may be assigned.

• Reviews, analyzes and oversight of prebill/post bill reviews and pending accounts
• Performs medical record reviews to determine coding accuracy of diagnosis codes, procedure codes, present on admission indicators, discharge disposition, and query compliance
• Conducts overall claims review to validate reporting accuracy of codes impacting reimbursement including, but not limited to ICD-10-CM, ICD-10-PCS, CPT/HCPCS, DRG, and POA assignment
• Creates clear, concise and accurate review findings and recommendations in written review reports that will be used for advising and educating Coders, and presented to Reviewers, Managers, and Directors throughout the organization
• Stays current with AHA, CMS, AMA/CPT and ICD-10-CM/PCS Official Coding and Reporting Guidelines Updates   
• Works to resolve workflow, systems and complex matters related to coding

KNOWLEDGE, SKILLS, ABILITIES

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.

• Proficient in inpatient and/or outpatient diagnosis and procedure coding guidelines
• Proficient in CPT/HCPCS code assignment including Evaluation & Management facility coding guidelines
• Knowledge of MS-DRG, APR DRG and CPT classification and reimbursement structures
• Proficient at writing AHIMA complaint physician queries
• Adept at comparing documentation, code assignment and charge in the financial system for accuracy and completeness
• Functional knowledge of facility EMR, encoder, CDI tool and other support software

Conifer requires its candidates, as applicable and as permitted by law, to obtain and provide confirmation of all required vaccinations and screenings prior to the start of employment.  This may include, but is not limited to, the COVID-19 vaccination, influenza vaccination, and/or any future required vaccines and screenings. 

EDUCATION / EXPERIENCE

• Required:  Three (3) to five (5) years’ experience performing medical record coding in acute care setting
• Required:  High school graduate or equivalent is required
• Preferred:  Associate or Bachelor’s Degree in Health Information, Nursing, or other related field, or formal coding classes completed and passed

CERTIFICATES, LICENSES, REGISTRATIONS

• Required:  AHIMA Credentials, and or AAPC - CCS preferred

PHYSICAL 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.      

• Must be able to work in sitting position, use computer and answer telephone
• Must be able to lift up to