Coding Integrity Specialist

Love + medicine is who we are, it's what we do, it's why people want to work here. If you're looking for a job to love, apply today.Schedule Weekly Hours:40 hours (1.0 FTE = 80 hours every 2 weeks). This position will be working remote; however, candidates must be within a reasonable driving distance to attend occasional meetings and training. We can only accept candidates from WI, IA, and MN.Job Description:The Coding Integrity Specialist works under the direction of the Manager of Clinical Documentation Improvement to ensure accurate and compliant coding of hospital and clinic services through coding review, continued education, and feedback to coding leadership and staff, along with the continual development and maintenance of an effective quality audit review program. This includes reviews of E&M, in-office procedures, ancillary services, Emergency Services, Urgent Care, and professional hospital services, including guidelines specific to prospective payment systems, Rural Health Clinic, and Critical Access Hospital. This individual will work independently on most assignments but will collaborate with Coding Services Managers, Supervisors, and Leads for planning and implementation.Major Responsibilities:Implements the department's internal quality control and assurance program. Performs internal audits to ensure staff compliance with coding and reimbursement guidelines. Provide input to a coding supervisor's assessment of a coder's adherence to ICD-10 CM and/or PCS coding conventions, the CPT rules established by the AMA, the AAPC code of ethics, and/or the AHIMA Standards of Ethical Coding and risk adjustment models, i.e., hierarchical condition category (HCC) coding.Coordinates and project manages internal and external audits.Monitors coding specialists' compliance with provider query policies to acquire documentation that supports appropriate procedure and diagnosis codes. Assesses the adequacy of documentation to support code assignment and escalates documentation issues according to departmental policy.Identifies opportunities for continued education based on audit assessments and coordinates with managers, supervisors, and leads to facilitate.Identifies potential opportunities for improved clinician documentation and alignment of the application of coding guidelines based on assessments.Demonstrates in-depth knowledge and technical expertise in code sets including CPT, HCPCS, ICD-10, as well as current national, regional, and local payer policies for coding, billing, and claims processing. Partners with leaders in Revenue Cycle and Clinical Documentation Improvement to monitor, research, translate, interpret, and communicate new developments and changes that will impact provider documentation and coding. Serves as an informational resource for coding staff and Revenue Cycle leadership.Collaborates with coding Supervisors to identify, assess, obtain, and deploy tools to support employees in their daily work such as reference material, staff development resources, and technology. Assists the Manager to review, evaluate, and recommend software applications that will enhance the efficiency and accuracy of code assignment.Manages multiple assignments and requests simultaneously and appropriately prioritizes ad hoc requests.Adheres to regular and predictable attendance.Performs other job-related responsibilities as requested.Education and Learning:REQUIRED:

Associate degree in Health Information Management or a related field, or a high school diploma or equivalency and a coding certification (see license and certification requirements).DESIRED:

Bachelor's degree in Health Information Management or a related field.Work Experience:REQUIRED:

5-7 years of experience in healthcare coding of multi-specialty clinics, hospital inpatient, or outpatient settings.DESIRED:

Experience as a coding auditor. 7+ years of experience in healthcare coding of multi-specialty clinics, hospital inpatient, or outpatient settings.License and Certifications:REQUIRED:

Registered Health Information Administrator (RHIA) or Registered Health Information Technician (RHIT) or Certified Coding Specialist (CCS) or Certified Coding Specialist - Physician based (CCS-P) or Certified Professional Coder (CPC) or Certified Coding Associate (CCA).DESIRED:

Certified Professional Medical Auditor (CPMA).Age Specific Population:N/AOsha Category:Category 3 - Employees in this job title have no reasonably anticipated risk of occupational exposure to blood and/or other potentially infectious materials.Environmental Conditions:Not substantially exposed to adverse environmental conditions (as in typical office work).Physical Requirements/Demands of The Position:Sitting Continually (67-100% or 8 hours).If you need assistance with any portion of the application or have questions about the position, please contact

HR-Recruitment@gundersenhealth.org

or call 608-775-0267.Equal Opportunity Employer

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