Conduct coding compliance audit projects for a variety of clinical settings and service lines at UnityPoint Health (UPH) and its affiliates. Evaluate coding for accuracy, completeness and consistency with internal policies and procedures, official coding guidelines, and regulatory guidance. Evaluate the efficiency, effectiveness and compliance of coding and documentation processes within the organization. Serve as a consultant \/ advisor to Internal Audit Clients on coding and billing related questions and projects. Respond quickly to requests of the UPH Legal department as necessary to perform confidential audits or high risk audits under Attorney Client Privilege. Communicate findings and recommendations to UPH and regional management in a professional and timely manner. Serve as a departmental resource for coding, compliance, and clinical questions related to audit work. Successful candidates with proven ability to work independently may have the benefit of working a portion of their schedule remotely from a home office. Secure, high speed internet access would be required to work remotely.Evaluate accuracy and sequencing of ICD-9\/ICD-10 CM\/PCS and\/or CPT codes for a variety of patient types, which may include inpatient, outpatient, ambulatory records, emergency room, and physician clinic records for proper coding, billing and reimbursement. Validate code(s), modifier(s), or MS-DRG\/APC assignment for consistency with internal policies and procedures, regulatory guidance, and official coding guidance (i.e., AHA’s Coding Clinic, the Official Guidelines for Coding and Reporting or CPT); depending on the clinical setting or service line reviewed. Validate accuracy of billing and advise UPH Revenue Cycle team regarding actions required if coding and billing are not in accordance with regulatory guidelines.Validate diagnosis and procedure codes assigned are adequately supported by documentation in the medical record.Adhere to AHIMA’s (American Health Information Management Association) Standards of Ethical Coding.Utilize basic audit skills as specified by UPH Internal Audit policies.Research and develop appropriate audit programs and testing procedures to address problem-prone or coding compliance risk areas. (Requires clinical and coding knowledge) Assess clinical documentation, coding and billing practices for compliance with regulations of federal and state agencies and third party payers; develop sound conclusions supported by audit evidence; identify opportunities to improve compliance and operating efficiency. Work with management to best improve staff education, compliance, and controls related to coding, billing and other regulatory issues.Utilize system software to efficiently research, document and test areas of risk.Regularly research and utilize outside resources to maintain and update knowledge of healthcare and audit issues. Participates in continuing education activities, and keep credentials up to date.Work collaboratively with other staff members to ensure optimal team functionality.Provide status reports on a regular basis for assigned projects.Maintains a high level of independence and objectivity.Perform special audit assignment and investigation as required.Maintains regular and consistent attendance at work.Adheres to all UPH Personnel policies and procedures, departmental policies and Safety guidelines.Behaves in a manner consistent with all Corporate Compliance policies and procedures. Education Associate’s Degree or higher in Medical Terminology or other clinical areas related to coding and billing requiredRequires one or more of the following certifications: Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Coding Specialist (CCS), Certified Coding Specialist – Physician Based, (CCS-P), Certified Professional Coder (CPC), Certified Professional Coder – Hospital Outpatient (CPC-H).
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