Location: Detroit, MI
Date Posted: 03-05-2017
Conducts review of hospital-based coding/billing to ensure accuracy and appropriateness, as well as compliance with government regulations. Responsible for conducting secondary review of Inpatient and Outpatient claims per Policies. Reviews the DRG Validation Log to ensure appropriate review and resolution of edits. Reviews referrals created by coding staff to ensure appropriateness of secondary review based on receipt of Vanguard edits. Meets with ancillary departments regarding charge referrals and works with departments to create a process to reduce the number of referrals. Trends referrals by department and shares information with appropriate administrative staff. Acts as a liaison with the regional CDM Manager and hospital ancillary departments regarding charging, coding, and documentation issues. Conducts monthly coding audits of high risk problem cases as directed by Corporate Compliance, and records results of audits in the 3M Audit expert system.
Assist Manager in coordination on internal and external audit results findings including insurance and RAC. Ensures audit findings have been re-billed and resolved. Audits appropriateness of physician queries through review of query reports and review of the actual physician query. Responsible for review of AE and/or ARMS reports. Analyzes claims returned by Xactimed to identify patterns and provide education to coders. Prepares written documentation and periodic reports as required by the department or hospital. Enhances professional growth and development through participation in educational programs, research/review of current literature, and attendance at in-service meetings and workshops. Stays current with government transmittals and memorandums, and assures that the appropriate information is passed to appropriate departments.  Acts as a technical resource to staff for independent projects and assumes role of team leader on group projects. Supervises and/or conducts complex and sensitive special projects, reviews, investigations, studies, or research projects. Enforces and assists in the development of interdepartmental flow and processes. Develops policies, procedures and processes to facilitate accuracy in the revenue cycle.
Minimum Qualifications 1. Bachelor’s degree in Health Information Management or related field, or the equivalent combination of education and/or experience. 2. Three years inpatient, hospital-based coding experience required 3. Certification as a Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Coding Specialist (CCS) or other coding certification related to the specialty area.
Very competitive salary and benefits!
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Full relocation package is available!
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KP Recruiting Group 
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