Coding Integrity Specialist

1 week ago

Ithaca, United States Cayuga Health System Full time

Coding Integrity Specialist


Cayuga Health and its affiliates are the region's leading healthcare system and most trusted providers of integrated health services, empowering our people in our mission to equitably improve the well-being of the communities we serve. Our commitment to providing extraordinary healthcare begins with our team of extraordinary professionals who are continuously discovering clinical innovations and enhancing access to the most up-to-date facilities, equipment, technologies, and research protocols. Cayuga Health's commitment to our employees includes competitive compensation, comprehensive employee benefits programs, and the opportunity to explore and build a career in healthcare through our many professional development programs. 


The Coding Integrity Specialist performs independent reviews of hospital medical records including inpatient, emergency department, outpatient and observation to ensure appropriateness of coding and charges. Reviews disputes and denials received from third party payers and review agents, Insurance Payers, IPRO, Livanta, etc. Works closely with the Coding Manager and Coding Team Supervisor to prepare education and training material based on coding guidelines, new technology, denials, medical practice and new trends discovered during chart audits.


Roles and Responsibilities:

  • Audits inpatient and outpatient medical record documentation for coding: DRG, APC and APG assignment accuracy and completeness.
  • Reviews of denials and third-party payers disputes (IPRO, Insurance (Including Medicare/Medicaid), Livanta, etc.) by performing the following:
    • Reviews medical record documentation for completeness and accuracy, coding guidelines, DRG assignment, SOI and ROM assignment.
    • Researches the AHA's coding clinic and official coding guidelines and other reference material to respond to disputes.
    • Reviews the sequencing of diagnoses and procedures following UHDDS guidelines and CMS regulations.
    • Collaborates with the attending physician of the medical director's office as needed for support of the diagnoses and procedures documented.
    • Responds within our denial management software to the CHS denials team to appeal.
  • Works with Coding Team to develop and deliver education for coding staff, including ICD10-CM and PCS annual updates
  • Works closely with the Revenue Cycle team to validate coding and charging.
  • Works closely with the Clinical Documentation team to review discrepancies in DRG assignments and to provide education.
  • Maintains coding credential(s) and required continuing education credits.
  • Maintains confidentiality of all patient information.
  • Excellent written and verbal communication skills.
  • Other duties as needed to meet the needs of the organization/department

Required Skills and Experience:

  • Two year degree in Health Information Management required
  • Five or more years of combined experience in coding and auditing
  • RHIT or RHIA credential required.
  • Working knowledge of ICD10 CM/PCS and CPT coding classification. Knowledge of DRG's, APC's and APG's.
  • Certification with AAPC or AHIMA, AHIMA preferred (RHIT, RHIA, CCS, etc).

Preferred Skills and Experience:

  • Bachelors preferred
  • Two or more years of supervisory/auditing experience preferred

Physical Requirements:

  • The position requires a high degree of mental and visual concentration. No lifting requirements. Requires long period of sitting, with repetitive motion.

Location and Travel Requirements:

  • Remote
  • Flex schedule option, Monday-Friday

Pay Range Disclosure:

  • $26.44 to $31.25 per hour

Cayuga Health System and its affiliates are committed to treating all patients, providers, staff and volunteers equitably and with dignity, ensuring the highest levels of safety, care and respect, and striving to recognize and overcome biases and policies that contribute to disparities in healthcare access, equitable care and positive health outcomes for all.


We are proud to be an Equal Employment Opportunity employer, supporting the growth and health of our employees and community by embracing the rich diversity, needs and circumstances of all peoples and prioritizing opportunities to build a diverse and inclusive workplace. We do not discriminate based upon race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable protected characteristics.


If you require reasonable accommodation to complete a job application, pre-employment testing, a job interview or to otherwise participate in the hiring process, please contact the Cayuga Health Talent Acquisition team at .



I certify that the information contained in this application is correct and complete to the best of my knowledge. I understand that any falsification or omission of information may disqualify me from further consideration for employment or, if hired, may result in termination. In consideration for my employment, I agree to abide by the rules and regulations of the company, which rules may be changed, withdrawn, added, or interpreted at any time, at the company's sole option and without prior notice to me.

I understand that any hiring decision is contingent upon my successful completion of all of the Company's lawful pre-employment/post-offer checks, which may include a background check, drug screen, employment references, and licensing review. If I am made a conditional offer of employment, I agree to execute any consent forms necessary for the Company to conduct its lawful pre-employment/post-offer checks. Such checks will not be conducted until allowed under applicable federal, state, and local law. I understand if I have a criminal background, it will not automatically disqualify me from employment unless otherwise required by law. I agree to execute any consent forms necessary for the Company to conduct its lawful pre-employment checks.

I also understand that the Company is a drug and alcohol-free workplace and has a drug and alcohol testing program consistent with applicable federal, state, and local law. I understand that after a conditional offer of employment, I must submit to and pass a pre-employment drug test as a condition of employment.



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