Coding Integrity Specialist

1 week ago

Nashville, United States Nashville General Hospital Full time
Description

Ensures full and efficient collection and processing of all information necessary for prompt and compliant billing and optimized reimbursement related to hospital facility services.
Duties and Responsibilities
  • Through direct efforts and coordination of the efforts of others, ensure timely and accurate coding of facility encounters, in a manner that is consistent with industry best practices.
  • Develop, implement, and consistently seek improvement in policies and procedures for all coding functions that lead to compliant billing and optimal reimbursement.
  • Works proactively with service areas to ensure charges are established, and hard and soft coding is maintained to ensure proper processing (eliminating edits)
  • In coordination with service departments, helps to ensure daily reconciliation of coding to include prior day visits and subsequent claims processed.
  • Coordination with billing office to ensure billing edits and insurance rejections and denials as impacted by coding are minimized.
  • Provide service of the highest quality in a professional and courteous manner to our internal customers, providers, and patients.
  • Provides training to physicians, clinicians, and all others who need to understand the full scope of coding from physicians' orders, authorizations, charges (CDM), compliant claim forms and prompt full reimbursement.
  • Active participation as a member of the administrative team in assisting others as needed to ensure all daily activities are completed, company goals are achieved, and continuous improvements and cost efficiencies are identified and pursued.
  • Constant review and recommends updates on coding changes; stays abreast of coding changes annually, quarterly, and on-going. Informs others as needed.
  • Assist in the training of department staff and providers to ensure documentation is adequate, industry protocols are met, and policy and procedures are followed.
  • Ensure compliance with industry standards, regulations, and company policy and procedure.
  • Strict adherence to HIPAA and related laws that protect patient privacy.
  • Audit medical notes and superbills for accuracy in CPT, HCPCS, ICD 10 and appropriate use of modifiers, making recommendations to management for maintenance.
  • Investigation, analysis & follow-up for collection of overdue accounts which may be due to charting, documentation, coding.
  • Assists the department as needed.
Required Education
College coursework, equivalent to associate degree, preferably in medical or business field.
Certified Professional Coder (CPC), CPC-Hospital

Optional Certifications
Certified Professional Medical Auditor (CPMA), Certified Revenue Cycle Representative (CRCR)

Experience
Must have at least 4 years' experience in facility coding.

We are an E-Verify employer.

For more information, please click on the following links:
E-Verify Participation Poster: English Spanish
E-Verify Right to Work Poster: English Spanish

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