Revenue Integrity Coding Specialist

Revenue Integrity Coding Specialist

Summary: Responsible for investigating and resolving all claim edits identified by the system including Correct Coding Initiative edits, Mutually Exclusive edits, Medically Unlikely Edits and LCD edits.

Responsibilities:

• Researches and corrects OCE/CCI and MUE Edit claims for resolution timely and accurately.
• Researches and corrects accounts sent for Revenue Integrity review by PFS and coding timely and accurately.
• Researches and corrects LCD edits for medical necessity and communicates to the Supervisor trends seen in coding accuracy.
• Communicates the trends of issues to the HIM Director and the PFS Director in order to promote a proactive setting to correct any preventable issues from hitting claim edits or DNB edits.
• Receives and coordinates external report results concerning claim edits and presents to the coding supervisor and HIM Director.
• Reviews, analyzes and abstracts physician/other documentation for diagnoses, procedures, ancillary testing, medications, laboratory and other services provided assigning the appropriate ICD 10 CM/ diagnosis codes and CPT 4 and ICD-10 PCS procedure codes.
• Utilizes a variety of software (e.g., Optum, Epic, PWC SMART, MS Office, etc.) to compile and validate medical information.

Other information: Education Associate Degree or a minimum of two years college education in Health Information Management or related field required. Licensure/Certification Registered Health Information Administrator (RHIA) or Registered Health Information Technician (RHIT) required, Certified Coding Specialist (CCS), or Certified Professional Coder (CPC). Experience Four or more years acute care outpatient coding experience required. Preferred: experience in assigning modifiers and CPT coding experience Knowledge, Skills and Abilities • Knowledge of ICD-10 CM/ PCS coding and CPT- 4 Coding including HCPCS level II • Knowledge of appropriate assignment of all hospital appropriate CPT modifiers • Knowledge of hospital billing concepts including CCI edits, MUE edits, LCD edits and general billing principles. • Ability to work within a multi-departmental team to identify correct billing and coding practices and submit clean claims • Ability to read, write and communicate effectively in English. • Proficient with MS Office particularly Excel, and EPIC, Optum software. Valid NC Driver's License: No If driving a Wayne UNC Vehicle, must be 21 years old and MVR must be approved by Risk Management.