The consultant performs compliance audits of medical records against coding guidelines, writing concise recommendations and presenting findings to coders during education exits. Responsibilities also include reviewing documentation for accuracy, utilizing various coding software, running reports, and conducting exit conferences with administration and coding staff.
* This is a remote/work from home position *
Overview
Performs compliance audits of Inpatient and Outpatient medical records in accordance with all coding guidelines. Writes and presents concise recommendation worksheets with appropriate findings and coding references to coders during education exits. Writes Executive Summaries and must communicate with different administrative levels within the hospital.
Responsibilities
Reviews records assigned to ensure all codes reported are accurate to ICD-10 CM/PCS and/or CPT coding conventions
Reviews additional chart documentation to validate admission order, admission and discharge dates, point of origin, patient status, present on admission indicator, and coder queries to ensure accuracy
Uses various software applications, groupers, 3M and other coding tools to analyze and ensure appropriate codes, sequencing and edits
Runs preliminary and final statistical and coder specific reports
Completes client rebuttals and makes appropriate changes in database
Prepares for Exit Conference using Teams
Conducts Exit Conference with Administration
Conducts Exit Conference with Coding Staff
Prepares summation of Exit Conference
Meets with HIM Director following Exit
Qualifications
High School Diploma with RHIA, RHIT, or CCS credential
Minimum 5 years inpatient and outpatient coding experience in an acute care facility.
I-10-CM/PCS proficient
Computer proficiency, able to research coding questions and utilize HIA’s internal educational resources
Experience using Electronic Health Record (EHR)
High Speed Internet via Cable (no Satellite or wireless cell based)
Independent, focused individual able to work remotely.
Sound organizational, communication and critical thinking skills
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