编码完整性专员
Coding Integrity Specialist
R1 是技术驱动解决方案的领先提供商，致力于改善医院、医疗系统和医疗集团的患者体验和财务表现。我们是唯一一家将全球收入周期专业人员的深厚专业知识与行业最先进的技术平台相结合的公司，该平台涵盖先进的分析、人工智能、智能自动化和工作流程编排。
作为我们的编码完整性专家，您将与编码完整性经理和编码运营总监合作，就潜在的编码质量问题建立畅通的沟通渠道。每天您将领导、协调并执行编码质量审查。要在这个职位上取得成功，您必须具备强大的分析能力，能够理解和分析大量操作数据，能够审查复杂的医疗记录，并具备强大的多任务处理和工作分配优先级排序能力
以下是您作为编码完整性专家将经历的工作内容：
· 进行与报销、公共报告和绩效付费相关的复杂编码审查。
· 与CDI团队合作，协助解决文档不一致、DRG差异以及CDI和内部运营问题，以确保KPI、SLA、RIS和DNFB要求得到满足。
· 确保DRG或报销准确反映医院提供的服务/资源使用情况，以优化病例组合指数报告的影响。
· 与医院/客户管理层合作，验证特定服务线和有助于医院判断该技术是否具有正向投资回报率的技术的正确编码。
· 执行第二层级的预付账单和后付账单账户审查，以确保编码准确，审查质量和风险（HAC、PSI、死亡率、核心指标和CMS计划），并进行最终审查的升级，可能包括核销批准。
· 进行复杂的360度编码审查，包括编码识别和更正，以及以下问题的趋势分析：文档、编码拒绝（如医疗必要性、计费和收费）
· 评估编码准确性/具体性，以帮助防止与基于价值的支付计划和公共报告相关的医院收入损失
· 通过自动化的个人通知，向编码员/编码经理提供教育/反馈，关于编码更正
查看英文原文
R1 is the leading provider of technology-driven solutions that transform the patient experience and financial performance of hospitals, health systems and medical groups. We are the one company that combines the deep expertise of a global workforce of revenue cycle professionals with the industry’s most advanced technology platform, encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration.
As our Coding Integrity Specialist, you will works with the Coding Integrity Manager and Director of Coding Operations to establish open lines of communication regarding potential coding quality concerns. Every day you will, leads, coordinates, and performs coding quality reviews. To thrive in this role you must, strong analytical skills and ability to comprehend and analyze large quantities of operational data, ability to review complex medical records and strong ability to multi-task and prioritize work assignments
Here’s what you will experience working as a Coding Integrity Specialist:
· Conduct complex coding reviews related to reimbursement, public reporting, and pay for performance.
· Collaborates with the CDI team, assisting with the resolution of documentation inconsistencies, DRG variances, and CDI and internal operations to ensure KPIs, SLA, RIS, and DNFB requirements.
· Ensures that the DRG or reimbursement accurately reflects the services/utilization of resources provided by the hospital to optimize the impacts of case mix index reporting.
· Collaborates with hospital/client leadership to validate proper coding for appropriate reimbursement for specific service lines and technology which assists hospitals in determining if that technology is a positive return on investment
· Performs second level focused pre-bill and post-bill account reviews to ensure accurate coding, review for quality and risk (HAC, PSI, Mortalities, Core Measures and CMS Initiatives) and escalation for final review which may include approval for write-off.
· Conduct complex 360 coding reviews which include identification and correction of coding, and trending for the following issues: documentation, coding denials i.e medical necessity, billing, and charging
· Evaluate for coding accuracy/specificity to assist with preventing possible loss of revenue for the hospital related to value-based payment programs and public reporting
· Provide education/feedback to coders/coding managers regarding coding corrections via automated individual notifications
· Identify coding trends that require formal education by the R1 Education and Training team and work with integration teams and project management teams to test and give feedback on updates to systems and mappings
· Perform ad hoc, Cloudmed DRG Validation Reviews or requests based on client specific wants or needs.
Required Skills:
· Bachelor's or associate’s degree in HIM related fields or CCS credential is required.
· Minimum 5 years of inpatient coding.
For this US-based position, the base pay range is $28.24 - $40.21 per hour . Individual pay is determined by role, level, location, job-related skills, experience, and relevant education or training.The healthcare system is always evolving — and it’s up to us to use our shared expertise to find new solutions that can keep up. On our growing team you’ll find the opportunity to constantly learn, collaborate across groups and explore new paths for your career.
Our associates are given the chance to contribute, think boldly and create meaningful work that makes a difference in the communities we serve around the world. We go beyond expectations in everything we do. Not only does that drive customer success and improve patient care, but that same enthusiasm is applied to giving back to the community and taking care of our team — including offering a competitive benefits package.
R1 RCM Inc. (“the Company”) is dedicated to the fundamentals of equal employment opportunity. The Company’s employment practices , including those regarding recruitment, hiring, assignment, promotion, compensation, benefits, training, discipline, and termination shall not be based on any person’s age, color, national origin, citizenship status, physical or mental disability, medical condition, race, religion, creed, gender, sex, sexual orientation, gender identity and/or expression, genetic information, marital status, status with regard to public assistance, veteran status or any other characteristic protected by federal, state or local law. Furthermore, the Company is dedicated to providing a workplace free from harassment based on any of the foregoing protected categories.
If you have a disability and require a reasonable accommodation to complete any part of the job application process, please contact us at 312-496-7709 for assistance.
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Originally posted on Himalayas