Revenue Integrity Corp Coding Analyst II

Orlando Health Revenue Integrity Specialist

At Orlando Health, we are ordinary people with extraordinary individuality, working together to bring help, healing and hope to those we serve. By daily embodying our over 100-year legacy, we have grown into a 3,900-bed healthcare organization that delivers care for more than 142,000 inpatient and 3.9 million outpatient visits each year. Our 24 award-winning hospitals and ERs, 9 specialty institutes, 14 urgent care centers, 100+ primary care practices and more than 60 outpatient facilities serve communities that span Florida's east to west coasts and beyond.

Orlando Health is committed to providing you with benefits that go beyond the expected, with career-growing FREE education programs and well-being services to support you and your family through every stage of life. We begin your benefits on day one and offer flexibility wherever possible so that you can be present for your passions. "Orlando Health Is Your Best Place to Work" is not just something we say, it's our promise to you.

Position Summary: Reviews and analyzes hospital accounts that have failed coding and charge related edits, including medical necessity, National Correct Coding Initiative (NCCI), Medicare Outpatient Code Editor (OCE), and other exceptions requiring clinical and coding expertise. Reviews interventional radiology and cardiology invasive procedures and assigns the appropriate clinical procedure, anesthesia charges, and supply charges in accordance with nationally recognized coding guidelines for technical Cardiology and Interventional Radiology services.

Responsibilities

Essential Functions:

• Extracts statistical data, performs Root Cause Analysis to generate supporting trends reports, and notifies Clinical Liaisons and Manager(s) of any identified trends.
• Works assigned Epic workqueues; assesses and corrects Correct Coding Initiative (CCI) and Medical Necessity (MN) edits, as well as post bill denials relating to the same.
• Manages and prioritizes tasks to meet deadlines for all projects and audits assigned.
• Provides ad-hoc multivariate reports to management.
• Independently coordinates edit resolution workflow.
• Works closely with Revenue Integrity Clinical Liaisons to ensure reconciliation of edits to meet department and organization goals.
• Utilizes extensive knowledge of ICD-10-CM, CPT, HCPCS, and modifiers.
• Locates and interprets local coverage determination (LCD) from our MAC (First Coast) and national coverage determination (NCD) from CMS.
• Assists in training new Revenue Integrity team members.
• Runs reports to identify unposted procedural logs.
• Analyzes medical information from medical records to accurately charge procedural and supply information in accordance with national coding guidelines and appropriate reimbursement requirements.
• Consults with clinical staff and/or providers to clarify missing or inadequate record information and determine appropriate diagnostic and procedure codes.
• Identifies clinical build gaps and works with the ITCE/ELLiE team on updating the build so clinical teams can document information and capture applicable charges.
• Provides education to clinical teams on coding and documentation guidelines to maximize charge capture and revenue reimbursement opportunities.
• Reviews quarterly and yearly CMS updates to ensure current policies and guidelines are being applied.
• Demonstrates exemplary customer service and critical thinking skills to include problem resolution and process improvement skills.
• Communicates cooperatively and constructively with multi-disciplinary teams.
• Demonstrates professional verbal and written communication skills.
• Maintains reasonably regular, punctual attendance consistent with Orlando Health policies, the ADA, FMLA and other federal, state, and local standards.
• Maintains compliance with all Orlando Health policies and procedures.

Other Related Functions:

• Maintains established work production and quality standards.
• Collaborates within the team to facilitate efficient and effective problem-solving to meet goals.
• Assumes responsibility for professional growth and development, including obtaining continuing education units/credits, to remain current with industry standards.
• Attends department meetings as required.

Qualifications

Education/Training:

• Associate's degree is required, preferably in business, healthcare, or a related field. Four (4) years of directly related work experience may substitute for the Associate degree (in addition to the requirements listed in the Experience section).
• Proficiency in medical terminology is required.

Licensure/Certification:

• Certified Physician Coder (CPC), Certified Coding Specialist (CCS), or Certified Interventional Radiology Cardiovascular Coder (CIRCC) from AAPC or AHIMA is required.

Experience Required:

• Five (5) years of hospital charging and/or coding experience is required.
• Extensive PC and Excel experience is required.
• EPIC Experience is preferred.
• Exceptional understanding of electronic medical records (EMR) and charge management.

Bayfront Health St. Petersburg