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Certified Coding Lead

St. Croix Regional Medical Center

Job Summary:

This position is responsible for coordinating and monitoring work of coding staff to ensure maximum A/R efficiency while in accordance with correct coding initiative guidelines and regulatory requirements. The lead serves as the first-line resource for coding and provides education on diagnosis and procedural coding as well as documentation requirements.

This position is also responsible for reviewing patient records and applies accurate evaluation and management (E&M) codes, ICD-10-CM/PCS codes, Current Procedural Terminology (CPT), and Healthcare Common Procedure Coding System (HCPCS) codes in accordance with official coding guidelines and regulatory requirements. Applies knowledge of medical terminology, disease processes, and pharmacology. Demonstrates tested data quality and integrity skills. Provide feedback to providers and work coding specific denials.

Job Description:

Assisting with coding of clinic visits, outpatient services, inpatient professional fees/facility fees, and surgical procedures
- Accurately assign correct ICD-10-CM/PCS, CPT and HCPCS, including modifiers for designated service lines
- Follows correct coding initiative guidelines and adheres to regulations governing correct coding.
Communicates with providers and clinical staff on correct coding initiatives and documentation requirements
- Interacts with medical staff in various settings to optimize and improve documentation.
- Collate, transfer and analyze audit results to capture and illustrate risk issues, revenue leakage, and educational opportunities.
Work with coding/billing team on denials and claim edits
- Will work coding specific denials, following official coding guidelines and correct coding initiative (CCI) edits ensure bill is coded appropriately
- Will work denial questions from coders, work with billing staff to resolve outstanding denials with coding questions
Serves as a resource to all partners relative to official coding guidelines to ensure compliance
- Understands the impact of clinical workflows on revenue cycle functions.
- Understands charting tools within Excellian (i.e. order entry, smart sets), diagnosis assignment, and the dropping of charges.
Provides quality customer service and communication to all departments, providers, coworkers and all other entities where there is interaction
- Communication/customer service are delivered in a respectful and professional manner
- Demonstrates the ability to deal with pressure, meet deadlines and be adaptable in changing situations
Monitors coding workflow, implements process improvements for problematic issues with team/supervisor
- Serves as the first line of support for Certified Coding Specialists
- Identifies when additional information is necessary and seeks clarification on any issue
- Maintains assignments for Certified Coding Specialists and coordinates temporary backup
- Provides guidance/expertise on process improvement to resolve issues
Maintenance of coding department policies and procedures
- Develop/updates procedure manuals to maintain standards for correct coding in assigned service lines
Conducts the training, growth, and development of staff members
- Provide training for new Certified Coding Specialists and current staff
- May provide orientation and training to other medical center staff relative to coding processes and procedures.
Keep up to date with coding guidelines and regulations
- Reads bulletins, newsletters, and periodicals and attends webinars to stay abreast of issues, trends, and changes in laws and regulations governing coding and documentation

* While this job description is intended to be an accurate reflection of the job requirements, management reserves the right to modify, add or remove duties from particular jobs and to assign other duties as necessary.

Education & Licensure:

Associates degree in Health Information Technology/Management, Healthcare Administration or equivalent work experience, required
Certification through AAPC (CPC, COC, CIC) or AHIMA (RHIA, RHIT, CCS, CCS-P) required

Apply Online: http://www.scrmc.org

Charge Audit Analyst

St. Croix Regional Medical Center

Introduction:

St. Croix Regional Medical Center is currently seeking a 1.0FTE Charge Audit Analyst. This position will work a hybrid remote schedule Monday-Friday 7:30 am-4:00 pm.

The Charge Audit Analyst is responsible for auditing workflows and documentation to ensure compliant charge capture throughout the organization while maintaining integrity with The Centers for Medicare and Medicaid Services (CMS) and other regulatory agencies. This position serves as a liaison between clinical processes and revenue cycle, conducts research and analysis, benchmarking, and analyzes data to ensure the accuracy of information. The Charge Audit Analyst will maintain knowledge of the various regulatory agency guidelines and assure requirements are met along with accurate, complete, and timely charge processes.

Job Description:

Audits and analyzes charges being captured by hospital departments for accuracy and completeness
- Analyzes findings for improvement opportunities
- Ensures that appropriate revenue is captured based on documentation from providers and nursing
In collaboration with leadership, identifies and implements best practices of charge capture through quality audits
- Develops education plans to assist service line leaders in achieving optimal reimbursement
- Recommends new categories for revenue capture
Monitors government and commercial payers for updates and changes to billing requirements
- Communicates with and educates hospital and administrative staff on any actions required to comply with regulations
Participates in chargemaster (CDM) maintenance efforts
- Reviewing charges to accurately reflect provided services/supplies
- Ensure charges are consistent with industry regulations and best practices
Develop individualized educational plans
- Improve provider accuracy where deficits are identified through internal or regulatory audits
Facilitates appropriate modifications to documentation
- Interact and collaborate with physicians, coding, case management, nursing and other caregivers to ensure appropriate documentation
Performs all duties and responsibilities in accordance with ethical and legal business procedures
- Compliant with federal and state statutes and regulations, official coding rules, guidelines and accepted standards of coding practice including appropriate clinical documentation policies
Responsible for training hospital departments
- Ensure compliant charge practice, annual CPT/HCPCS code updates, and charge capture improvement
Serves as subject matter expert related to charging and billing issues
- Assists in developing and maintaining revenue capture-related policies and procedures
Performs root-cause analysis for system-related charge capture failures.
- Works in collaboration with Excellian IT support and department staff to ensure charge capture functionality is optimized and efficient

Experience:

Minimum three years healthcare experience, required. Five years healthcare experience preferred.
Minimum of three years chargemaster, billing, or coding experience, required.
Clinical Documentation Integrity experience, preferred.
Epic experience, preferred

Education & Licensure:

Associate’s degree in Business Administration, Healthcare Administration, Health Information Management, or Finance, required.
Bachelor’s degree in Business Administration, Healthcare Administration, Health Information Management, or Finance, preferred.
Coding Certification (AHIMA or AAPC), preferred.

Compensation/Benefits:

Here at St.Croix Regional Medical Center, we offer our employees with a robust benefits package that includes: