Reviews preservice and concurrent admission and continued-stay requests to determine medical necessity and the appropriate level of care, using clinical judgment and applicable guidelines. Coordinates with physicians, care teams, and other providers on complex cases, supports utilization and quality improvement, and ensures documentation and processes meet regulatory standards.
The senior coder reviews inpatient and outpatient medical records to assign accurate ICD-10 and CPT codes using 3M software. They collaborate with clinical and financial teams to ensure DRG accuracy while maintaining established quality and productivity standards.
The manager is responsible for overseeing the Payment Integrity Program, including managing staff and coordinating audit activities to ensure accurate medical claims payment. They will collaborate with executive leadership and various business units to set program goals and execute cost containment strategies.
Performs internal quality assessment reviews and education for inpatient facility coders to ensure adherence to coding guidelines and policies. Acts as a liaison between the coding department and providers to improve documentation quality and reimbursement accuracy.
