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!
Conducts routine and risk-based coding compliance audits, random quality compliance audits, and semi-annual quality compliance audits of professional fee encounters to validate code assignments are in compliance with official coding guidelines as supported by clinical documentation in the health record. Validates abstracted data elements that are integral to appropriate payment methodology.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Include the following. Others may be assigned.
Understands, interprets and applies coding guidelines for coding audits ofmulti-specialty professional encounters. Performs medical record reviews to determine coding accuracy of evaluation and management services, surgical and office-based procedures, and diagnosis codes. Validates compliance with non-physician practitioner billing, teaching physician and scribe services, as applicable. Conducts overall claims review to validate reporting accuracy of codes impacting professional reimbursement including, but not limited to, CPT, ICD-10-CM, HCPCS, Modifier and POS.
Creates clear, concise and accurate audit findings and recommendations in written audit reports that will be used for advising and educating Healthcare Providers, Coders, Auditors, Managers, and Directors throughout the organization.
Identifies documentation issues (lacking documentation, split/shared visit services, etc.) that impact coding accuracy. Clearly communicates (verbally and in written reports or summaries) opportunities for documentation improvement related to coding issues.
Stays current with CMS, AHA, AMA/CPT and ICD-10-CM Official Coding and Reporting Guidelines, and other agency directives for professional fee coding. Completes online education courses and attends mandatory coding workshops and/or seminars (MPFS, IPPS, and OPPS, ICD-10-CM and CPT updates) for all coding types.. Reviews AHA and CPT quarterly coding update publications. Attends all internal conference calls for Quarterly Coding Updates.
Provides input regarding departmental budget specific to area of responsibility.
KNOWLEDGE, SKILLS, ABILITIES
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.
Ability to consistently and accurately audit coding of professional fee encounters
Ability to create clear and concise audit reports
Maintain productivity standards
Must successfully pass pre-hire professional fee coding assessment
Knowledge of CMS, ICD-10-CM, CPT-4 and HCPCS coding regulations, guidelines and methodologies
Knowledge of medical terminology, anatomy, disease pathophysiology and drug utilization
Knowledge of billing guidelines related to correct claim submission including POS and billing provider
Knowledge of NCCI classification and reimbursement structures
Must be detail oriented and have the ability to work independently
Computer knowledge of MS Office
Must display excellent interpersonal skills
Ability to demonstrate initiative and discipline in time management and assignment completion
Ability to work in a virtual setting under minimal supervision
EDUCATION / EXPERIENCE
Include minimum education, technical training, and/or experience preferred to perform the job.
Associates degree in relevant field preferred or combination of equivalent of education and experience
Three (3) years coding experience with a focus on professional fee coding
One (1) year of experience in coding audit or quality review work of professional fee services in multiple specialties
Include minimum certification required to perform the job.
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.
Must be able to work in sitting position for extended periods
Must be able to efficiently use computer, keyboard and mouse to perform audit work assignments and answer telephone
Ability to travel
Duties may require driving an automobile to off- site locations.
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.
Remote ï¿½ Telecommuting
Approximately 15% travel may be required
Job: Conifer Health Solutions
Primary Location: Frisco, Texas
Job Type: Full-time
Shift Type: Days
Employment practices will not be influenced or affected by an applicantâ��s or employeeâ��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.
Internal Number: 2005042107
About Conifer Health Solutions
Tenet Healthcare Corporation (NYSE: THC) is a diversified healthcare services company headquartered in Dallas with 112,000 employees. Through an expansive care network that includes United Surgical Partners International, we operate 65 hospitals and approximately 510 other healthcare facilities, including surgical hospitals, ambulatory surgery centers, urgent care and imaging centers and other care sites and clinics. We also operate Conifer Health Solutions, which provides revenue cycle management and value-based care services to hospitals, health systems, physician practices, employers and other clients. Across the Tenet enterprise, we are united by our mission to deliver quality, compassionate care in the communities we serve.