Code Edit Analyst

Code Edit Analyst

The purpose of this position is to create consistency and efficiency in claims processing and data collection by applying the appropriate diagnostic and procedural codes to individual patient health information. Coordinates the processing of medical services for Medical Necessity and Correct Coding Initiative requirements. Utilizes advanced knowledge of specialty coding to analyze patient medical records, ensuring that documentation by providers conforms to legal and procedural requirements. Assigns specified codes to medical diagnoses and/or clinical procedures. The Code Edit Analyst performs audits of complex medical records for coding and billing accuracy. The analyst will assist Billing Manager and other team members in the coordination of reports concerning audit outcomes such as code errors, revenue impact for the facility, and data processing errors. The Code Edit Analyst also will provide support to other projects as assigned within the Revenue Cycle Division as well as other Performance Improvement initiatives. This includes, but is not limited to, other projects related to contract compliance, charge description master, coding/pricing, and new product development.

Responsibilities include performing daily coding reviews on claims as assigned, to validate the ICD-10, CPT, HCPCS codes and modifier assignments. Develops reports, collects and prepares data for process improvement, and financial impact of systemic billing and coding errors. Compares UB04 data to medical record documentation to ensure compliance with Medicare and other insurance reporting requirements. Ability to identify coding and billing problems as they pertain to pre-bill and claims records review. Develop process improvement initiatives from which problems can be resolved. Must understand CMS memos and transmittals. Understand medical records, hospital bills, and the chargemaster. Understand ancillary department functions. Ability to communicate orally and in written form. Perform professional and hospital related charge reviews for appropriateness of coding and charging, including business office activities, systems function and charging methodologies. Identifies patterns, trends, and variations in assigned professional and hospital claims, and evaluates the causes of identified problems. Takes appropriate steps in collaboration with the right department to effect resolution or explanation of the variance. Demonstrates ability to effectively manage multiple projects with innovation, creativity and vision. Documents results of all special projects and provides recommendations for revenue managing opportunities. Illustrates creative problem-solving skills through documentation of process improvement reporting and/or internal reporting mechanisms. Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association and AAPC. Reports to leadership when areas of concern are identified.

Minimum requirements include a minimum of bachelor's degree or higher in a health service-related discipline. Five years of extensive experience with a certificate in coding may be substituted. Previous auditing experience preferred. National Certification in an area relevant to Revenue Management or Coding is preferred. Good oral and written communication skills. A comprehensive knowledge of CMS payment systems.

Skill set requirements include proficiency in reimbursement methodologies, hospital information systems and coding methodologies. Ability to analyze complex medical records and identify billable services. Strong quantitative, analytical, and organizational skills. Understanding of medical records, professional/hospital claims, and the Charge master. Ability to utilize and understand computer technology. Ability to understand ancillary department functions. Possesses a working knowledge of various payment and coding methodologies, including ICD-10, HCPCS and CPT-4 coding schemes. Possesses a working knowledge of the UB-04/837 claim form loop and segments. Understands charging, coding processes along with compliance issues. Has the ability to provide resolutions by performing internet research, utilizing third party payor regulations, referencing coding guidelines, and referencing local Fiscal Intermediary and CMS guidelines. Requires knowledge of medical terminology, anatomy and physiology. Must be team-oriented with strong interpersonal skills. Knowledge of the Privacy Act to safeguard patient confidentiality. Certified Coding Specialist or Certified Procedural Coder.

Standards of performance include demonstrating increased revenue and compliance as a result of successful accuracy and correctness of the following: Identification of over and under coding as supported by medical record documentation and coding standards. As indicated, resolves claims processing questions, through medical record analysis. Provides support to the clinical or ancillary departments regarding their charging practices. Documents observations and proactively identifies new revenue opportunities. Provides education to revenue producing department staff as requested by department managers and or directors. Works with department managers and directors to facilitate mandated changes. Meets productivity and accuracy standards as defined by Billing Manager or Revenue Cycle Leadership Team. Identifies and initiates performance improvement projects and follows through in the completion of the projects to result in operational efficiencies and revenue cycle excellence.

Pay range is $28.58 - $41.66/hr. This is a remote role (based out of Greenville, NC) with a Monday - Friday full-time day shift: 8:00 a.m. - 5:00 p.m. Great benefits are offered.