Coder/Abstractor - Revenue Integrity (Pawleys Island, SC)

Responsibilities: Knowledge/Skills/Abilities:

• Extensive knowledge in revenue cycle processed. Ability to interface with all levels of the organization effectively Incorporating regulatory requirements and performing data input and analysis and QA. Extensive experience in effective problem-solving skills, project management skills, and conflict resolutions skills.
• Knowledge of federal, state and accreditation standards; knowledge of governmental and other regulatory standards, requirements and guidelines related to quality improvement.
• Excellent analytical skills to analyze complex problems and develop effective solutions for correction.
• Ability to design and implement effective staff education and training programs.
• Comprehensive understanding of the entity’s revenue cycle, including a thorough understanding of proprietary system and any applicable systems and tools, the entity revenue capture and processes, and billing requirements.
• Advanced leadership skills to resolve critical issues and make strategic decisions to contribute to the organizational goals and objectives
• Ability to utilize and administer the disciplinary action process through coaching and counseling to improve performance or terminate employment.
• Ability to work on various assignments simultaneously.
• Strong interpersonal skills within all levels of the organization.
• Ability to navigate within automated systems and proficiency in Outlook, Word and Excel.
• Demonstrated ability to interpret, analyze, develop, direct and implement overall expectations as it relates to large scale implementations and projects and interpret situations and information and offer guidance and quality decisions.
• Ability to identify and redesign inefficient workflow and processes.
• Proficiency with financial data with regards to charging, billing and reimbursement.
• Excellent written and verbal communication including the ability to resolve conflicts with tact and diplomacy.
• Possess strong interpersonal skills in order to integrate and successfully function with all levels of the organization.

Position Summary:The Revenue Integrity Coder/Abstractor is responsible to analyze and assign ICD-10-CM diagnostic and procedure codes, CPT and HCPCS codes to all patient accounts, based on medical information provided and consistent with regulatory guidance and best practices in the industry and Tidelands Health policy and procedure. Abstract key data requirements from the medical information consistent with UHDDS requirements, other regulatory and best practices. The RI Coder/Abstractor will meet specified productivity and accuracy standards and complete other RI duties as assigned. This position is responsible for ensuring that charges for services provided to patients are captured for billing. This will include performing reconciliations and using historical reports to identify lost revenue opportunities. The position will collaborate with care givers and informatics specialists and assist with facilitating proper charge capture and clinical documentation practices.
Essential Functions and Job Duties:

• Completes accurate and timely charge capture by enter charges where necessary and reviewing clinical documentation to validate all charges are captured.
• Enter and reconciling of emergency and observation charges.
• Emergency charges within one day of discharge unless mental health and observation charges within three days of discharge.
• Reviews and reconciles the Revenue and Usage report daily.
• Works assigned charging reports daily.
• Educates caregivers on charge capture as omissions or errors are identified.
• Identifies inconsistencies and works with supervisors or clinical leaders to streamline charge capture process.
• Follows compliant charge capture in accordance with Medicare, Medicaid or Third Party payer guidelines.
• Communicates with various members of the billing team with the understanding that billing begins with the capture process.
• While performing the duties of this job, the employee will be required to work under stress and adapt to changing conditions. Must have the ability to exercise judgment and know when to obtain the approval of a supervisor. Must be able to perform assigned job functions accurately and in a timely manner.
• Ability to adhere to strict confidentiality requirements.

Other duties as assigned.
QUALIFICATIONS
Experience:

• Previous Experience as healthcare coder required.
• Firm understanding of the Medicare IPPS, OPPS and ASC payment system.
• Prior experience coding emergency department facility and professional fees as part of a hospital system preferred.Preferred Experience:

• Experience with APC reimbursement, CMS rules and regulations, coding and billing compliance, preferred. Possesses working knowledge of various payment and coding systems, particularly OPPS, HCPCS and CPT-4 coding schemes.
• Experience working Meditech and ECW (CDM and/or Revenue Integrity), preferred.
• Experience in multi-hospital organizations.
• Experience with Optum 360 CDM Master.

Education:

• High school Diploma required.
• Post-secondary education preferred.

Certification/Credentialing:

• Candidates must meet at least one the following criteria:

• Currently credentialed as CPC (Certified Professional Coder)
• Certified Coding Specialist (CCS®)
• Registered Health Information Administrator (RHIA®)
• Registered Health Information Technician (RHIT®)

Physical Requirements: Light Physical Agility Test (PAT) RatingWhile performing the duties of this job, the employee is frequently (activity or condition exists from 1/3 to 2/3 of the time) required to stand, sit, and walk; frequently to use hands, fingers; and frequently to talk or hear. The employee must exert up to 15 pounds of force occasionally (activity or condition exists up to 1/3 of the time), and/or up to 5 pounds of force frequently, and/or a negligible amount of force constantly to move objects.
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.