HIM Cert Coder​/Quality Review Analyst OP ! REMOTE

Overview

This position is responsible for timely and accurate quality review of both internal and vendor coding team members to assure compliance with coding guidelines and standards in addition to their foundation coding responsibilities. The position performs quality checks on coding and provides feedback to coders to assure the timely and accurate coding of medical charts for billing. This position also reviews and response to coding-based denials for inpatient, hospital outpatient and professional fee claims and advises leadership on trends related to denials.

In collaboration with HIM coding management, the coder/quality review analyst will assist with selection of coders and encounters to be reviewed, as well as education to be presented to the coder based on review outcomes. The coder/quality review analyst will also bring forward any issues related to documentation or systems as they are discovered during the review process. This position participates in the onboarding process of new coders, which may require intensive audits and reviews until the coder is fully trained and released.

• Perform accurate and timely quality reviews of internal and vendor coding team members using appropriate code sets and coding guidelines.
• Develop and perform timely coding education to internal and vendor coding team members on coding systems, coding standards, protocols and Carle coding workflow as required based on quality review outcomes.
• Perform as a production coder when needed in a manner aligned with current coding productivity and quality standards.
• Share results of quality reviews to HIM Leadership with recommendations for education and training.
• Work with HIM leadership to determine frequency and scope of coding quality reviews for specific coders and vendors.
• Compile and track statistics related to the review function, completed quality reviews, and follow up from those reviews.
• Identify coder training needs, system issues, and/or documentation issues and report them timely to HIM leadership.
• Review and respond to coding denials and coding questions as requested or assigned and perform clinical validation of appeal letters as needed.
• Assist in editing appeal letters ensuring clinical documentation support and regulatory guidelines are considered.
• Participate in system and new application testing as needed.
• Review and resolve coding-based denials using EPIC WQs or other software.
• Provide denial trending data to leadership as requested.
• Work with Manager to analyze denied claims and identify trends for education.
• Serve as subject matter expert (SME) for coding denials providing guidance and education to coding staff, physicians and other hospital departments.
• Provide regular reports to management on denial trends, appeal outcomes and overall performance metrics.
• Identify work types to be reviewed based on the coding scope and new coder onboarding needs of the HIM department.
• Develops and performs HIM coding team member group education on coding topics identified during quality reviews and denial reviews.
• Assist the HIM coding management in assuring all coding performed by HIM or HIM vendors meets department standards.

• Certifications:
  
  CPC, CPC-P, CCA, CCS, RHIA, RHIT (as applicable) per American Academy of Professional Coders (AAPC) and American Health Information Management Association (AHIMA) guidelines.
• Education:
  
  Selected formal education in health information management or related field.
• Work Experience:
  
  Coding.

Find it here.

Discover the job, the career, the purpose you were meant for. The supportive and inclusive team where you can thrive. The place where growth meets balance – and opportunities meet flexibility. Find it all at Carle Health.

Based in Urbana, IL, Carle Health is a healthcare system with nearly 16,600 team members in its eight hospitals, physician groups and a variety of healthcare businesses. Carle Bro Menn Medical Center, Carle Foundation Hospital, Carle Health Methodist Hospital, Carle Health Proctor Hospital, Carle Health Pekin Hospital, and Carle Hoopeston Regional Health Center hold Magnet® designations, the nation’s highest honor for nursing care.

The system includes Methodist College and Carle Illinois College of Medicine, the world’s first engineering-based medical school, and Health Alliance™. We offer opportunities in several communities throughout central Illinois with potential for growth and life-long careers at Carle Health.

We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class. Carle Health participates in E-Verify and may provide the Social Security Administration and, if necessary, the Department of Homeland Security with information from each new employee s Form I-9 to confirm work…