Job Summary
Analyze and interprets the documentation in the medical record utilizing current coding classification system to the diagnoses. Assists in resolving insurance denials and participates in appeal process. Performs chart audits and provides education and training on coding. Has a strong knowledge of auditing concepts and principles, medical coding and billing systems and regulatory requirements. Has the ability to use independent judgment and to manage and impart confidential information and the ability to analyze and solve problems. Has strong communication and interpersonal skills. The medical coder/auditor has a working knowledge of legal, regulatory, and policy compliance issues related to medical coding and billing procedures and documentation. The medical coder/auditor maintains an understanding of developing issues and trends in medical coding procedures requirements, has the ability to clearly communicate medical information to professional practitioners and/or the general public and a detailed knowledge of medical coding systems, procedures, and documentation requirements. Home Health coders will review OASIS.
Essential Job Functions
- Hospice coders will review all necessary information from medical records to assist the Medical Director/hospice team physician(s) to identify the terminal diagnosis for hospice and all other conditions whether related or non-related using current coding classification system.
- Coders will code records using ICD-10-CM coding guidelines.
- Home Health Coders will review the OASIS. Review documentation and provide ICD-10 coding recommendations based on current coding and Oasis guidelines.
- Codes new admissions for primary and supporting diagnoses based on doctor’s recommendations and documentation received in the medical record.
- Updates the medical record with additional diagnoses as patient’s condition changes and review of documentation noted at Interdisciplinary Team Meetings.
- Audits medical record documentation. Will identify undercoded and upcoded services as well are regulatory compliance; prepares reports of findings and meets with providers to provide education and training on accurate coding practices and compliance issues.
- Provides second-level review of billing performances to ensure compliance with legal and procedural policies and to ensure optimal reimbursements while adhering to regulations prohibiting unbundling and other questionable practices.
- Researches, analyzes, and responds to inquiries regarding compliance, inappropriate coding, denials, and billable services.
- Interacts with physicians and other patient care providers regarding billing and documentation policies, procedures, and regulations; obtains clarification of conflicting, ambiguous, or non-specific documentation.
- Attends coding conferences, workshops, and in-house sessions to receive updated coding information and changes in coding and/or regulations.
- Works with the Medical Staff, Service Integrity, Team Administrators and Leaders to provide feedback to support educational opportunities on coding and clinical documentation.
- Requests additional medical records as needed for supporting documentation
- Stays up to date on changes to the physicians fee schedule and other coding resources such as IDC-10 codes.
- Maintains privacy and confidentiality of patient's Protected Health Information (PHI) according to Avow’s organizational policies and procedures.
- Compiles information to assist in analyzing Quality Control and Performance Improvement audits in regard to coding and claims.
- Maintains knowledge of current coding guidelines and obtains continuing education units to maintain coding credentials.
- Prepares the organization for changes in coding requirements.
- Monitors HIPAA compliance and reports breaches to the Privacy Official.
- Assists with other coding initiatives for any Avow Inc. company
- All other duties as assigned.
Core Values
Integrity: We are honest, hardworking, fiscally responsible professionals driven solely by the wellbeing of our patients, their loved ones, and the communities we serve.
Education: We believe it is important not only to serve the community but to educate community members about our services and the role we play through life’s transitions.
Collaboration: We know we cannot achieve everything we want without working together with each other, with our healthcare partners, and with the community.
Innovation: We embrace change and are always looking at creative ways to solve problems and serve new populations.
Celebration: We believe in the importance of celebrating life and relationships.
Education/Experience
Bachelor’s degree (B.A.) from four-year college or university; or three to four years related experience and/or training; or equivalent combination of education and experience preferred. Credentialed in Health Information (RHIA or RHIT) preferred and credentialed in coding (CPC, CCS, CCA, HCS-H) required within 1 year. Home Health Coders will require certification in OASIS after 1 year. Minimum of 3 years of experience in billing and coding with hospice or home health experience preferred.
Certificates, Licenses, Registrations
Certified Professional Coder (Required within 1 year)
Current Driver’s license
Computer Skills
Strong computer skills including database software and general knowledge of e-mail/Outlook.
Supervisory Responsibilities
This job has no supervisory responsibilities.
Language Skills
Communication skills of reading, writing, and speaking in English. Spanish speaking preferred.
Math Skills
Math skills including addition, subtraction, multiplication, division, and percentages/fractions.
Physical Demands
(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.) While performing the duties of this job, the employee may be required to sit, stand, walk, and reach with hands and arms, use hands to finger, handle, or feel. The employee may be required to stoop, kneel, crouch, or crawl. The employee may need to lift and/or move up to 10 pounds. Employee may also be required to see, hear, and talk.
Work Environment
(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.) The noise level in the work environment is usually moderate.
Infection Control Category: III
Compensation And Benefits
This is only a summary of our employee benefits; it is subject to change.
- Medical insurance (PPO) with prescription drug co-pay or HDHP w/HSA
- Supplemental Benefits (hospital confinement, accident and/or cancer)
- Dental insurance
- Vision Insurance
- Life and accidental death/dismemberment insurance (company paid)
- Long term care insurance (company paid)
- Retirement savings plan (TSA/403(b) matching program)
- Short and long term disability insurance (company paid)
- LegalShield (identity protection and more)
- Bereavement leave for family and pets
- Direct deposit
- Credit union availability
- Employee Assistance Program
- Paid time off
- Mileage reimbursement
- In-house continuing education opportunities
- Discounted membership at local area Fitness Center
- Tuition reimbursement
- Other employer-sponsored activities
Avow is a Tobacco Free Organization which includes but is not limited to cigarettes, electronic cigarettes, vaping, cigars, cigarillos, pipes, chewing tobacco, snuff, dip, and loose tobacco smoked via pipe or hookah. And due to the above, Avow will only hire Nicotine Free individuals.
