Coding and Data Integrity Expert

6 days ago


Ithaca, New York, United States Cayuga Health System Full time
Job Description:

Cayuga Health System is seeking a skilled Coding and Data Integrity Expert to join their team. This role plays a crucial part in ensuring the accuracy and integrity of medical records, coding, and charges.

The successful candidate will be responsible for performing independent reviews of hospital medical records, including inpatient, emergency department, outpatient, and observation cases, to ensure appropriateness of coding and charges. Additionally, they will review disputes and denials received from third-party payers and review agents, such as Insurance Payers, IPRO, Livanta, etc.

The Coding and Data Integrity Expert will work closely with the Coding Manager and Coding Team Supervisor to prepare education and training materials based on coding guidelines, new technology, denials, medical practice, and new trends discovered during chart audits.

Key Responsibilities:
  • Audit inpatient and outpatient medical record documentation for coding: DRG, APC, and APG assignment accuracy and completeness.
  • Review denials and third-party payer disputes 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.
  • Work with the Coding Team to develop and deliver education for coding staff, including ICD10-CM and PCS annual updates.
  • Work closely with the Revenue Cycle team to validate coding and charging.
  • Work closely with the Clinical Documentation team to review discrepancies in DRG assignments and to provide education.
  • Maintain coding credentials and required continuing education credits.
  • Maintain confidentiality of all patient information.
  • Excellent written and verbal communication skills.
  • Other duties as needed to meet the needs of the organization/department.
Requirements:
  • 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 Requirements:
  • Bachelor's degree preferred.
  • Two or more years of supervisory/auditing experience preferred.
Estimated Salary:

$26.44 - $31.25 per hour.

Cayuga Health System is committed to providing equitable care and respect to all patients, providers, staff, and volunteers, while striving to recognize and overcome biases and policies that contribute to disparities in healthcare access, equitable care, and positive health outcomes for all.


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