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Overview

Coder Specialist, Centralized Coding

Full Time, 80 Hours Per Pay Period, Day Shift

Covenant Health Overview:

Covenant Health is East Tennessee’s top-performing healthcare network with 10 hospitals (http://www.covenanthealth.com/hospitals/) and over 85 outpatient and specialty services (http://www.covenanthealth.com/services/) , and Covenant Medical Group (http://www.covenantmedicalgroup.org/) , our area’s fastest-growing physician practice division. Headquartered in Knoxville, Covenant Health is a community-owned, not-for-profit healthcare system and the area’s largest employer with over 11,000 employees.

Covenant Health is the only healthcare system in East Tennessee to be named six times by Forbes as a Best Employer.

Position Summary:

This individual provides leadership, direction, and training for the coding staff. Working directly with the physicians, Manager of Corporate Coding Services, Director of Registration/Admitting, and medical staff education efforts, serves as the user advocate between Health Information Management (HIM), Clinical Effectiveness, and Registration. Other job duties include: improving health record documentation and coding accuracy, developing and updating all departmental policies and procedures relative to coding, performing quality reviews of coding/abstracting, and focusing on problem solving issues related to denials. Provides assurance that billing practices are complete, accurate, and in compliance with state and federal guidelines.

Recruiter:Kathleen Rice || kkarnes@covhlth.com || 865-374-5386

Responsibilities

• Oversees through monitoring and by reviewing and auditing the coding staff to ensure position accountabilities and performance criteria are adhered to.

• Develops and maintains departmental and hospital policies and procedures and implements new policies and procedures relative to coding.

• Educates and assists physicians and clarifies coding versus clinical issues.

• Works closely with Registration and Business Office personnel to resolve issues related to claims, coding, pre-cert, and denials appeals, and verifies that appropriate chargemaster rates are used.

• Reviews medical record documentation to ensure existing documentation supports diagnostic/procedure code billed per UB 92 or HCFA 1500 form.

• Provides education to coding staff and physicians in response to regulatory changes and identified areas of deficiency.

• Monitors claim rejections and systematically assesses specific types of denial as it relates to coding and documentation issues, outpatient registration, and the receipt of physician orders.

• Attends meetings and provides input as it relates to coding, medical documentation, and reimbursement issues specific to medical billing and regulatory requirements.

• Increases awareness of compliance as it relates to coding and documentation.

• Facilitates and coordinates education of coding staff in the areas of coding, documentation, case mix, and denials.

• Increases understanding of APCs, DRGs, case mix, and denials.

• Educates coding staff to proper documentation necessary to support a DRG/APC/Medical Necessity/ROM/SOI.

• 13 Integrates documentation, coding, and proper oversight to ensure accurate reimbursement.

• Reviews records to verify if the correct code has been assigned.

• Assists with all insurance requested audits and provides information to supervisor related to inaccurate and/or missing documentation.

• Reviews DRG/APC classifications and educates to maximize level of care assignment for increased reimbursement.

• Keeps current on local, state, and federal regulations to ensure compliance.

• Keeps current on coding guidelines and communicates to Health Information Manager. Implements corrective actions as indicated to minimize financial risk.

• Works with Denials Elimination Group and deals with physician specific issues as it impacts denials.

• Ensures LCDs/NCDs are being adhered to by admissions and hospital personnel to ensure qualifying diagnosis covers tests/procedures.

• Analyzes denials and coordinates appeals.

• Ensures corrective action is taken to prevent denials from reoccurring.

• Follows policies, procedures, and safety standards. Completes required education assignments annually. Works toward achieving goals and objectives, and participates in quality improvement initiatives as requested.

• Performs other duties as assigned.

Qualifications

Minimum Education:

None specified; however, must be sufficient to meet the standards for achievement of the below indicated license and/or certification as required by the issuing authority.

Minimum Experience:

Five or more (5+) years coding experience.

Licensure Requirement:

RHIA, Coding, or RHIT certification required. Registered Health Information Technologist preferred.

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Job Title CODING SPEC-CLINIC

ID 4141901

Facility Covenant Health Corporate

Department Name CENTRALIZED CODING