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HIM Coding Edit Analyst

Pay Range: Min: $24.60 Mid: $30.76. Pay is based upon relevant education and experience.

POSITION PURPOSE: 

The HIM Coding Edits Analyst will assist the HIM department in reviewing denials, identifying root cause for denial management prevention, and resolving claim edits to ensure clean claim processing.

ESSENTIAL JOB FUNCTIONS: 

  1. Review facility and professional claim edit failures ensuring correct coding, application of applicable modifiers, and/or assist with charge correction to ensure a clean claim submission. Will be working in denial management, identifying trends, reviewing denied claims, reporting to leadership for educational opportunities within the coding department. Assist coding department in the coding queues as needed.
  2. Verifies patient information to identify any documentation vs. report discrepancies and to ensure edits and denials are resolved in a compliant manner.
  3. Recognizes and reports unusual circumstances and/or information with possible risk factors to appropriate risk management and HIM Coding Manager and reports problems, errors, and discrepancies in dictation and patient records to HIM Coding Manager. While reviewing the record for coding purposes, serves as quality reviewer of scanned documents. Identifies mis-scans and poorly scanned documents and reports them to HIM Director
  4. Collaborates with others in the organization including Medical Staff, other clinicians, and physician office staffs; and with Patient Financial Services to ensure the codes submitted for claims are supported by the documentation in the record. As needed, involves the HIM Director or HIM Coding Manager. Promptly addresses edits and questions from Patient Financial Services within one business day. May participate in various hospital/physician committees as appropriate
  5. Attends all required in-services and coder meetings. Identifies and attends training and educational programs conducive to professional growth. Utilizes current literature and workshops attended to the benefit of Vail Health. New ideas, policies, regulations, and philosophies are adapted to current policies and procedures appropriately.
  6. Supports the philosophy, objectives, and goals of Vail Health and the HIM department by volunteering in various capacities without compromising performance expectations. Role models the principles of a Just Culture.
  7. Contributes to the efficiency of the HIM department. Routinely volunteers to assist others when his/her work is completed.
  8. Routinely abides by standards of professional and ethical conduct as defined by CMS, AHIMA, and the professional organization from which the incumbent is certified and/or credentialed.
  9. Understands and complies with policies and procedures related to medicolegal matters including confidentiality, amendment of medical records, release of information, patient rights, medical records as legal evidence, informed consent, etc. Is knowledgeable of and complies with Vail Health Safety and Compliance Program Policies and Procedures.
  10. Role models the principles of a Just Culture and Organizational Values.
  11. Perform other duties as assigned. Must be HIPAA compliant

This description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills and efforts or work conditions associated with the job. It is intended to be an accurate reflection of the general nature and level of the job.

MINIMUM QUALIFICATIONS:

Experience:

  • 3 years of working NCCI/CMS (National Correct Coding Initiative) edits, MUE (Medically Unlikely Edits) , and working outpatient denials. Must have a strong understanding of facility and professional outpatient coding including ambulatory surgery coding.
  • Meets productivity requirements: All productivity requirements include accessing records on-line, abstracting, maintaining logs, handling paper records as needed, keeping current with office email, reviewing claims and/or following up with physicians for clarification of documentation and/or additional conditions to possibly support medical necessity, and running reports required to perform one’s work) Routinely achieves or exceeds quality expectations of 95% accuracy for coding . Must achieve quality and productivity expectations within 90 days of employment

License(s):

  • N/A

Certification(s):

  • RHIT, CCS, CCS-P or CPC

Computer / Typing:

  • Cerner and 3M computer system experience preferred but not required.
  • Must possess the computer skills necessary to complete work assignments, online learning requirements for job specific competencies, access online forms and policies, complete online benefits enrollment, etc. Use of number pad on keyboard preferred.
  • Ability to search resources and/or Internet to locate CMS and third party payer websites for coding requirements and medical necessity guidelines is required.
  • Competent in accessing and using an encoder (3M or Trucode), required

Must have working knowledge of the English language, including reading, writing, and speaking English.

Education:

  • High school diploma/GED, Graduate of a Medical coding and billing certificate program, Associates in Health Information Management, or Bachelor of Health Information Management

As a condition of employment, Vail Health requires COVID-19 vaccination of all clinical and non-clinical staff.

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