nThrive

Coder/Charge Auditor

Job ID
2021-29338
Employment Type
Full Time
Hours Per Week
40
State
Remote

Overview

The Coder/Charge Auditor will review clinical documentation to assign and sequence diagnostic and procedural codes for specific patient types to meet the needs of hospital data retrieval for billing and reimbursement. Specialists validate APC calculations in order to accurately capture the diagnoses/procedures documented in the clinical record. The Coder/Charge Auditor will perform documentation review and assessment for accurate abstracting of clinical data to meet regulatory and compliance requirements. Coder/Charge Auditor may interact with client staff and providers. The Coder/Charge Auditor will review clinical documentation to verify ordered and completed intervention’s, use of supplies, and cross reference patient account for accuracy.

Responsibilities

  • Selects and sequences ICD-9, ICD-10, and/or CPT/HCPCS codes for designated patient types which may include but not limited to: Acute Inpatient, Observation, Ambulatory Surgery; Wound Care, Emergency Department, Ancillary (Diagnostic) / Recurring; Interventional Radiology; Hospital Clinic; Physician Pro Fee; Technical Fee; Evaluation and Management.
  • Reviews and analyzes clinical records to ensure that MSDRG/APC assignments accurately reflect the diagnoses/procedures documented in the clinical record.
  • Abstracts clinical data from the record after documentation review to ensure that it is adequate and appropriate to support diagnoses, procedures and discharge disposition is selected.
  • Acts as a resource with client staff for data integrity, clarification and assistance in understanding and determining appropriate and compliant coding practices including provider queries.
  • Maintains strict patient and provider confidentiality in compliance with all federal, state, and hospital laws and guidelines for release of information.
  • Participates in client and nThrive staff meetings, trainings, and conference calls as requested and /or required.
  • Maintains current working knowledge of ICD – 9 and ICD-10 and/or CPT/HCPCS and coding guidelines, government regulations, protocols and third-party requirements regarding coding and/or billing.
  • Participates in continuing education activities to enhance knowledge, skills, and maintain current credentials.
  • Performs audits of medical records to identify and/or defend charges, including but not limited to: Concurrent Audits and Retrospective Audits.
  • Identifies, researches and analyzes billing errors and/or omissions, working with appropriate staff/team members; ensures that revisions/corrections forwarded and incorporated in processing systems in timely manner. 
  • Determines, requests, and obtains appropriate supporting documentation from hospital, physicians, current medical literature and patient.
  • Works with clinical departments and other impacted departments to ensure audit findings are addressed and to assist in implementing best charging practice moving forward
  • Becomes familiar with assigned facilities Charge Description Master (CDM) and departmental charge protocol.
  • Stays current with CMS, AHA & state coding/charging & reimbursement guidelines.
  • Organizes and prioritizes multiple cases concurrently to ensure departmental workflow and case resolution.
  • Enter saudit findings and/or data into nThrive computer-based system.
  • Proficiently utilizes multiple computer-based systems to complete and document work.
  • Other duties as assigned to meet client expectations that would include root cause analysis, research of complex charging issues, implementation of corrective actions & provide subject matter expertise during system upgrades & implementations.
  • Use of client based billing, internal based billing, medical record and quality systems.
  • Supports nThrive’s Compliance Program by adhering to policies and procedures pertaining to HIPAA, FDCPA, FCRA, and other laws applicable to nThrive’s business practices. This includes: becoming familiar with nThrive’s Code of Ethics, attending training as required, notifying management or nThrive’s Helpline when there is a compliance concern or incident, HIPAA-compliant handling of patient information, and demonstrable awareness of confidentiality obligations.

 

Qualifications

  • High School Diploma or GED.
  • Active RHIA or RHIT or CCS, COC (formerly CPC-H), CCS-P, CPC.
  • At least one year of recent hands-on coding experience with all record types: acute inpatient and outpatient experience.
  • Knowledge of medical terminology, anatomy and physiology, pharmacology, pathophysiology, as well as ICD-9/10 and CPT/HCPCS code sets.
  • Ability to consistently code at 95% threshold for both accuracy and quality while maintaining client-specific and/or nThrive production and/or quality standards.
  • Must display excellent interpersonal and problem solving skills with all levels of internal and
  • external customers.
  • Experience in medical records review, claims processing or revenue cycle.
  • Fundamental knowledge of Medicare/Medicaid Guidelines.
  • Proficiency accessing multiple databases simultaneously or managing multiple open screens to gather information.
  • Demonstrated ability to navigate Internet Explorer and Microsoft Office.
  • Proficiency with MS Outlook, MS Word, MS Excel and EMR.
  • Able to communicate clearly, both in writing and verbally.

Preferred Skills

  • Active RN/LPN/LVN.
  • Clinical or clinical auditing experience.

About nThrive

 

Be Inspired. Ignite Change. Transform Health Care.

From Patient-to-Payment, nThrive provides all the technology, advisory expertise, services, analytics and education programs health care organizations need to thrive in the communities they serve. Our colleagues share a united passion to help health care organizations strengthen their financial position, which translates to accessible, quality care for all. This passion fuels our drive to innovate and participate in community outreach through the nThrive CARES program. Our colleagues are encouraged to think differently and empowered to make a lasting impact that ensures our health care providers, and our world, are healthy and productive.

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