This position reports to the Associate Director of HIM and is responsible for ongoing quality review and assessment of coded hospital data. Performs audits on the accuracy of ICD-10, CPT-4, MS-DRG, APR-DRG and APC assignments. Performs review of claims denied for coding, documentation and clinical validation. Formulates and submits letters of appeal. Prepares reports for management review and identifies trends. Conducts focused retrospective audits and regular scheduled audits of individual coders. Manages all audits conducted by internal and external entities and responds to requests for code verification. In conjunction with the Coding Supervisors and Coding Manager, contributes to the development of educational and training opportunities for staff.
Job Opening Qualifications
Minimum Education and Experience Requirements:
Registered Health Information Administrator (RHIA), Certified Coding Specialist (CCS), Registered Health Information Technician (RHIT), Certified Professional Coder (CPC), Certified Professional Coder-Hospital (CPC-H) or Registered Nurse (RN) with education and experiential training in medical coding, utilization review, denial management, case management or related functions.
AHIMA Certified ICD-10-CM/PCS Trainer preferred.
Must have a minimum 5 years of experience in hospi-cl inpatient and/or outpatient medical record review, coding and reimbursement. Coding audit experience preferred.
Must have strong knowledge of ICD-9 CM/ICD-10 CM/PCS and CPT coding and prospective payment systems and proficiency with Microsoft Windows operating systems and Office applications, such as Word, Excel, PowerPoint and coding/grouping software.
Able to work well with minimal supervision.
Able to communicate clearly both written and verbally.
Able to generate reports for management review that present audit results in a clear manner.
Able to meet deadlines and respond well to frequent changes in regulation.
Able to maintain positive and productive relationships with internal and external teams and customers.
Able to work independently and be a self-starter.
Registered Health Information Administrator (RHIA), Certified Coding Specialist (CCS), Registered Health Information Technician (RHIT), Certified Professional Coder (CPC), Certified Professional Coder-Hospital (CPC-H) or Registered Nurse (RN).
We invite you to join our team! Our work and passion for excellence are intended to have an impact beyond the communities in which we serve. You may apply for a maximum of 10 positions at any given time. For general application process topics please review our Frequently Asked Questions. For technical assistance please contact Human Resources at 352-265-0441.
UF Health Shands Hospital is committed to diversity as a competitive advantage in attracting top talent from across the nation and around the world. We believe in sharing knowledge, learning from one another, valuing different opinions, and celebrating the things that make each one of us unique in our own right. UF Health Shands Hospital is an equal opportunity employer and drug-free workplace. Equal Opportunity Employer M/F/D/V