*New hires must have started the vaccine process or be fully vaccinated against the COVID-19 virus by the date of hire, unless granted an accommodation for a qualified medical or religious vaccine exemption.

FIND YOUR FUTURE

We're excited about the potential people bring to our organization. You can grow your career here while enjoying first-class perks, benefits and commitment to diversity and inclusion.

Overview

The Clinical & Coding Specialist-Senior will be responsible for reviewing coding and clinical decisions on cases involving complex clinical presentation with correlating coding complexity. They will aid in training other team members, evaluating appeals, and share audit trends across the team. . Expertise and proficiency demonstrated by long-standing, consistent results, advanced coding knowledge and auditing skills evidenced by their ability to train others, to identify coding patterns and share knowledge and audit tips across the team. The Clinical & Coding Specialist-Senior will support the leadership in Hospital Audit in accomplishing all aspects of the audit plan.

Qualifications

• Associates degree required. Bachelors degree preferred. An additional two years of experience in lieu of degree will be accepted.




• Minimum of one of the following certifications or licensures: Certified Inpatient Coder (CIC), Registered Health Information Management Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Clinical Documentation Specialist (CCDS), American Health Information Management Association (CCS-H, CCS-P), Certification Denials and Appeals Management (C-DAM), NYS licensed RN or LPN required. LPN or RN preferred.




• Four (4) years of clinical and coding audit experience required, preferably in an inpatient setting.; Knowledge of ICD-10-CMand ICD-10-PCS coding systems, as well as respective reimbursement methodologies associated with each coding system required.




• Demonstrated experience and proficiency reviewing health care delivery against clinical, quality, as well as financial established guidelines.




• Demonstrated analytical and critical thinking skills. Ability to ensure that clinical information translates correctly into claim coding in compliance/ with requested data set. Ability to prepare quantitative and qualitative studies at conclusion of audit. Ability to recalculate reimbursement following conclusion of audit in accordance with corporate provider contracts and/or Independent Health policy and procedures.




• Autonomous/Independent worker, minimal supervision, including process management skills. Demonstrated subject matter expert in all coding systems and/or inpatient clinical expertise.




• Demonstrated ability to serve as effective team member of cross-functional teams and/or proven ability to facilitate teams and foster collaboration internally and externally .




• Demonstrated understanding of organizational business strategies as well as audit and reimbursement related business strategies.




• Demonstrated organizational skills, verbal & written communication skills with ability to effectively communicate with personnel and providers externally.




• Demonstrated PC/Windows skills with proficiency in Microsoft Word, Excel.. Experience with remote access - citrix, VPN, external EMR access.




• Knowledge of facility contract reimbursement policies.




• Proven examples of displaying the IH values: Passionate, Caring, Respectful, Trustworthy, Collaborative, and Accountable.

Essential Accountabilities

• Assume role of project manager as it relates to the re-engineering of the hospital audit process.




• Responsible for the ongoing management of Inpatient Medical Admission and Readmission audits to include trends of clinical findings and financial recoupment statistics.




• Perform validation of diagnosis and procedure coding by reviewing medical record documentation and/or provider claims data. Ensure coding compliance with Industry standard ICD-10-CM and ICD-10-PCS coding guidelines and financial policies/contracts.




• Responsible for all reconsideration clinical appeals to include review of records, consultation with Medical Director, responses to facilities as well as coordination of all aspects of these functions for external review agent process (Dispute Resolution Agency).




• Serve as the subject matter expert for each audit to include internet research of industry standards (clinical/coding), that may be used to assist in the creation or revision of Independent Health policies and procedures.




• Prepare and present audit results as needed, to various levels of internal senior leadership for approval of financial recoveries, provider education, and/or recommendation for next steps.

As an Equal Opportunity / Affirmative Action Employer, Independent Health and its affiliates will not discriminate in its employment practices due to an applicant's race, color, creed, religion, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender identity or expression, transgender status, age, national origin, marital status, citizenship, physical and mental disability, criminal record, genetic information, predisposition or carrier status, status with respect to receiving public assistance, domestic violence victim status, a disabled, special, recently separated, active duty wartime, campaign badge, Armed Forces service medal veteran, or any other characteristics protected under applicable law. Click here for additional EEO/AAP or Reasonable Accommodation information.

Current Associates must apply internally via their Career Worklet.