Edit Coder

As a part of the Tenet and Catholic Health Initiatives family, Conifer Health brings 30 years of healthcare industry expertise to clients in more than 135 local regions nationwide. We help our clients strengthen their financial and clinical performance, serve their communities and succeed at the business of healthcare. Conifer Health helps organizations transition from volume to value-based care, enhance the consumer and patient healthcare experience and improve quality, cost and access to healthcare. Are you ready to be part of our solutions? Welcome to the company that gives you the resources and incentives to redefine healthcare services, with a competitive benefits package and leadership to take your career to the next step!

This position will be functioning under minimal supervision and utilizing independent decision making. This position is to problem solve and complete edits with consistency and efficiency. The Edit Coder will investigate and solve edit issues and communicate root cause data to management to solve problems upstream and downstream.

Responsible for modifying and completing moderate to high complexity coding and charging edits/errors using ICD-10-CM, CPT and HCPCS or any other designated coding classification system in accordance with coding rules and regulations. Abides by the Standards of Ethical Coding as set forth by AHIMA. Abstracting required clinical information from the medical record. Working in Bill Scrubber systems a requirement.

1. Performs data quality reviews on outpatient encounters to validate the ICD-10-CM, CPT, and HCPCS Level II code and modifier assignments, APC group appropriateness, missed secondary diagnoses and/or procedures, and ensure compliance with all APC mandates and outpatient reporting requirements. Monitors medical visit code selection by departments against facility specific criteria for appropriateness. Assists in the development of such criteria as needed. Monitors facility CRC reports for prebill edits related to APC. Addresses CCI and LCD edits within the various billing scrubbers while abiding by the Standards of Ethical Coding as set forth by the American Health Information Management Association. Meets and/or exceeds Conifer�s APC specialist productivity standards.

2. Reviews claim denials in comparison with medical records for the determination of accurate assignment of all documented diagnoses and procedures adhering to the standards of ethical coding.

3. Professional Development: Stays current with AHA Official Coding and Reporting Guidelines, CMS and other agency directives for ICD-10-CM/PCS, ICD-10 initiatives, and CPT/HCPCS coding. Stays current with CMS annually updated National Correct Coding Initiative Coding Policy Manual, CMS coding and billing regulations, MUE and OCE.

4. Monitors inpatient and outpatient unbilled accounts report for outstanding and/or uncoded outpatient encounters to reduce accounts receivable days for outpatients. Brings identified issues to department managers for resolution.

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Advanced personal computing skills including MS Outlook, MS Word, MS Excel

• Advanced technical skills required to learn and navigate a variety of software systems, trouble-shoot computer problems, install periodic updates to software programs and work efficiently in a virtual environment

• Strong written and verbal communication skills

• Ability to think/work independently, yet interact positively with team

• Advanced problem-solving skills and ability to quickly analyze a situation.

• Attention to detail is crucial to this position.

• Other functions as deemed necessary to complete and final bill claims accurately

Include minimum education, technical training, and/or experience required to perform the job.

• Outstanding interpersonal communication skills as well as excellent oral and written communication skills

• Knowledge of medical terminology, anatomy and physiology, disease process, and surgical procedures

• RHIA, RHIT or CCS preferred but not required.

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Ability to lift 15-20lbs

• Ability to sit and work at a computer for a prolonged period of time completing assessments and analysis

• Includes ability to walk through hospital-based departments across broad campus settings, including Emergency Department environments

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Characteristic of typical office environment requiring use of desk, chair, and office equipment such as computer, telephone, printer, etc.

• Work environment is at a moderate noise level.

• Professional appearance and demeanor

Employment practices will not be influenced or affected by an applicant�s or employee�s race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship.