HIM Cert Coder/Quality Review Analyst OP Team A
Carle
HIM Cert Coder/Quality Review Analyst OP Team A
- Category
- Support Services
- Position Type
- Full-Time
- Remote
- Yes
- Shift
- Day
- Schedule
- Monday-Friday
- Weekend Requirements
- None
- Holiday Requirements
- None
- On-Call Requirements
- None
Overview
Responsibilities
Develop and perform timely coding education to internal and vendor coding team members on coding systems, coding standards, protocols and Carle coding workflow as required based on quality review outcomes.
Perform as a production coder when needed in a manner aligned with current coding productivity and quality standards
Shares results of quality reviews to HIM Leadership with recommendations for education and training
Works with HIM leadership to determine frequency and scope of coding quality reviews for specific coders and vendors
Compile and track statistics related to the review function, completed quality reviews, and follow up from those reviews
Identifies coder training needs, system issues, and/or documentation issues and reports them timely to HIM leadership
Review and respond to coding denials and coding questions as requested or assigned and performs clinical validation of appeal letters as needed. Assists in editing appeal letters ensuring clinical documentation support and regulatory guidelines are considered.
Participates in system and new application testing as needed
Review and resolve coding-based denials using EPIC WQs or other software. Provide denial trending data to leadership as requested
Works with Manager to analyze denied claims and identify trends for education.
Serves as subject matter expert (SME) for coding denials providing guidance and education to coding staff, physicians and other hospital departments.
Provides regular reports to management on denial trends, appeal outcomes and overall performance metrics.
Identifies work types to be reviewed based on the coding scope and new coder onboarding needs of the HIM department Develops and performs HIM coding team member group education on coding topics identified during quality reviews and denial reviews Assist the HIM coding management in assuring all coding performed by HIM or HIM vendors meets department standards
Qualifications
Carle Health Company Overview
Find it here.
Discover the job, the career, the purpose you were meant for. The supportive and inclusive team where you can thrive. The place where growth meets balance – and opportunities meet flexibility. Find it all at Carle Health.
Based in Urbana, IL, Carle Health is a healthcare system with nearly 16,600 team members in its eight hospitals, physician groups and a variety of healthcare businesses. Carle BroMenn Medical Center, Carle Foundation Hospital, Carle Health Methodist Hospital, Carle Health Proctor Hospital, Carle Health Pekin Hospital, and Carle Hoopeston Regional Health Center hold Magnet® designations, the nation’s highest honor for nursing care. The system includes Methodist College and Carle Illinois College of Medicine, the world’s first engineering-based medical school, and Health Alliance™. We offer opportunities in several communities throughout central Illinois with potential for growth and life-long careers at Carle Health.
We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class. Carle Health participates in E-Verify and may provide the Social Security Administration and, if necessary, the Department of Homeland Security with information from each new employee's Form I-9 to confirm work authorization. | For more information: human.resources@carle.com.
Salary Range
Carle Health offers a comprehensive benefits package for team members and providers. To learn more visit careers.carlehealth.org/benefits.
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