Coding & Audit Analyst

Employment Type:

Full time

Shift:

Description:

Mission Statement:

• We, St Joseph's Health and Trinity Health, serve together in the spirit of the Gospel as a compassionate and transforming healing presence within our communities.

Vision:

• To be world-renowned for passionate patient care and outstanding clinical outcomes.

Core Values:

• In the spirit of good Stewardship, we heal by practicing Justice in fostering right relationships to promote common good, Reverence in honoring the dignity of every person, Excellence in expecting the best of ourselves and others; Integrity in being faithful to who we say we are.

POSITION PURPOSE

Performs annual and targeted medical record audits including, but not limited to analysis of medical record documentation; validation of primary and secondary diagnoses and procedures; and ensuring proper assignment of diagnosis and procedure codes by providers. Monitors accuracy of centralized coders charge capture and coding.

Partners with centralized coding and operational leadership to improve HCC, high risk scoring, along with provider and coder education. Responsible for practitioner education in areas related to coding, documentation, and compliance.

ESSENTIAL FUNCTIONS

Knows, understands, incorporates, and demonstrates the Trinity Health Mission, Vision, and Values in behaviors, practices, and decisions. Responsibilities, including but not limited to:

Educate providers on documentation guidelines, in annual sessions and individually as required.

Determine if organizational policies are current and effective.

Ensure appropriate revenue is captured; and

Defend against federal and payer audits, malpractice litigation, and health plan denials

Compare evaluation and management code utilization by provider, with comparison to national benchmarking, to identify potential outliers and audit risks.

Perform provider targeted and focused prospective and retrospective audits of documentation compared to services billed for new and established providers. Coordinate and partner with local ministry and System Office Integrity and Compliance benchmarks and standards.

Plans, prepares, and regularly conducts audits/reviews and other compliance related projects within an area of expertise relative to a specific healthcare service line. Works closely with external consultants and other ministries (when applicable) in performing similar audits. Reports timely on compliance issues detected through audits/reviews and compliance monitoring to their Regional Manager.

Responsible for writing reports that document the findings from audits/reviews. Engages Regional Manager on the development of performance improvement plans within their specific area of subject matter expertise. Acts as a technical resource for documentation, coding and billing regulations for assigned medical groups and regions.

Prepares and performs audit related educational sessions and presents those sessions in collaboration with medical group providers, division leadership, and within group settings or one-on-one. Train and assist in the education, audit, and development of the Centralized Coding team. Assists in the development of audit tools (e.g. audit programs, planning memorandum and the like) and utilizes those tools to analyze, trend, and identify variations to established procedures and compliance with rules and regulations.

Effective verbal, written, and interpersonal communication skills with the ability to comfortably interact with diverse populations. Performs medical record audits based on organizational enterprise Policy & Procedure. Performs accurate resolve of assigned auditing charge review and claim edits WQs in defined timeframe.

Develops, collaborates, and maintains effective relationships with site managers, practitioners, and leadership. Submits audit result corrections to PFS and other appropriate billing teams for correction. Maintains annual CEU requirement, keeps abreast of changing regulations, and pending legislation. Other duties as needed and assigned by the manager Maintains a working knowledge of applicable Federal, State, and local laws/regulations, the Trinity Health's Integrity and Compliance Program and Code of Conduct, as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical, and professional behavior.

MINIMUM QUALIFICATIONS

Associate degree in Health Information Management or a related field or an equivalent combination of years of education and experience. Bachelor's degree in Health Information Management (HIM) or related healthcare field is preferred.

Must possess a comprehensive knowledge of professional coding, regulatory guidelines, and payer policies with three (3) to five (5) years of professional coding or auditing experience Applicants will take the departmental coding test during the interview process. Test results will be used in the hiring process as a skillset assessment. Required: CPC, CRC, RHIT, CDEO, or equivalent certification Preferred:

CPMA or CCDS-O in conjunction with CPC, RHIT, CRC or CDEO accreditation Preferred: Extensive knowledge of medical data auditing, interpretation, and analysis. Preferred: Four (4) to six (6) years of professional coding experience; ability to code from operative reports, progress, and other note types.

A Must have an in-depth knowledge of Medicare and Medicaid documentation, coding, and billing regulations for applicable service lines(s) assigned, in addition to CMS Conditions of Participation. Additional knowledge of other third-party payer requirements for documentation, coding and billing preferred. Ability to review clinical documentation to determine accurate ICD10, CPT, HCPCS and modifier assignment.

Ability to work collaboratively in a team-oriented environment with a strong customer-service orientation Ability to work remotely from home following Trinity remote work guidelines. Demonstrated dependability and regular attendance. Ability to demonstrate competency with a standard desktop and Windows-based computer system, including a basic understanding of email, e-learning, intranet, and computer navigation.

Ability to use other software as required to perform the essential functions of the job. Expert in ICD-10 and CPT coding and medical terminology, with knowledge of Medicare, Medicaid, Health Maintenance Organization, and commercial insurance plans. Ability to maintain accurate records and to prioritize and organize work effectively. Ability to exercise independent judgment as appropriate within standard practices and procedures

LEADERSHIP COMPETENCIES

As a Trinity Health Executive, the incumbent is expected to demonstrate leadership traits, which support our Mission Statement and Core Values as identified below:

Mission Statement: We, Trinity Health, serve together in the spirit of the Gospel as a compassionate and transforming healing presence within our communities.

Core Values:

• Reverence: We honor the sacredness and dignity of every person.

• Commitment to Those who are Poor: We stand with and serve those who are poor, especially those most vulnerable.

• Justice: We foster right relationships to promote the common good, including sustainability of Earth.

• Stewardship: We honor our heritage and hold ourselves accountable for the human, financial and natural resources entrusted to our care.

• Integrity: We are faithful to those we say we are.

PHYSICAL AND MENTAL REQUIREMENTS AND WORKING CONDITIONS

This position operates in a remote environment. Incumbent communicates frequently, in person and over the phone, with people in all locations on product support issues.

Manual dexterity is needed to operate a keyboard. Hearing is needed for extensive telephone and in person communication. The environment in which the incumbent will work requires the ability to concentrate, meet deadlines, work on several projects at the same time and adapt to interruptions.

Must be able to set and organize own work priorities and adapt to them as they change frequently. Must be able to work concurrently on a variety of tasks/projects in an environment that may be stressful with individuals having diverse personalities and work styles. Ability to thrive in a fast-paced, multi-customer environment, with conflicting needs which some may find stressful.

May warrant varied and/or extended hours, with changes in workload and priorities to keep pace with the industry and advance strategic priorities. Must possess the ability to comply with Trinity Health policies and procedures.

The above statements are intended to describe the general nature and level of work being performed by persons assigned to this classification. They are not to be construed as an exhaustive list of duties so assigned

Our Commitment to Diversity and Inclusion

Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core Values, we integrate diversity, equity, and inclusion in all that we do.

Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A diverse and inclusive workforce provides the most accessible and equitable care for those we serve.

Trinity Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by law.