[Hiring] Code Edit Analyst @ECU Health Medical Center

Role Description

The purpose of this position is to create consistency and efficiency in claims processing and data collection by applying the appropriate diagnostic and procedural codes to individual patient health information.

• Coordinates the processing of medical services for Medical Necessity and Correct Coding Initiative requirements.
• Utilizes advanced knowledge of specialty coding to analyze patient medical records, ensuring that documentation by providers conforms to legal and procedural requirements.
• Assigns specified codes to medical diagnoses and/or clinical procedures.
• Performs audits of complex medical records for coding and billing accuracy.
• Assists Billing Manager and other team members in the coordination of reports concerning audit outcomes such as code errors, revenue impact for the facility, and data processing errors.
• Provides support to other projects as assigned within the Revenue Cycle Division and other Performance Improvement initiatives.

Qualifications

• Minimum of bachelor's degree or higher in a health service-related discipline.
• Five years of extensive experience with a certificate in coding may be substituted.
• Previous auditing experience preferred.
• National Certification in an area relevant to Revenue Management or Coding is preferred.
• Good oral and written communication skills.
• A comprehensive knowledge of CMS payment systems.

Requirements

• Proficient in reimbursement methodologies, hospital information systems, and coding methodologies.
• Ability to analyze complex medical records and identify billable services.
• Strong quantitative, analytical, and organizational skills.
• Understanding of medical records, professional/hospital claims, and the Charge master.
• Ability to utilize and understand computer technology.
• Possesses a working knowledge of various payment and coding methodologies, including ICD-10, HCPCS, and CPT-4 coding schemes.
• Possesses a working knowledge of the UB-04/837 claim form loop and segments.
• Understands charging, coding processes along with compliance issues.
• Ability to provide resolutions by performing internet research, utilizing third party payor regulations, referencing coding guidelines, and referencing local Fiscal Intermediary and CMS guidelines.
• Requires knowledge of medical terminology, anatomy, and physiology.
• Must be team-oriented with strong interpersonal skills.
• Knowledge of the Privacy Act to safeguard patient confidentiality.
• Certified Coding Specialist or Certified Procedural Coder.

Benefits

• Pay Range: $28.58 - $41.66/hr
• Remote role (based out of Greenville, NC)
• Monday - Friday full-time day shift: 8:00 a.m. - 5:00 p.m.
• Great Benefits

Standards of Performance

• Demonstrate increased revenue and compliance as a result of successful accuracy and correctness of the following:
• Identification of over and under coding as supported by medical record documentation and coding standards.
• Resolve claims processing questions through medical record analysis.
• Provide support to the clinical or ancillary departments regarding their charging practices.
• Document observations and proactively identify new revenue opportunities.
• Provide education to revenue producing department staff as requested by department managers and/or directors.
• Work with department managers and directors to facilitate mandated changes.
• Meet productivity and accuracy standards as defined by Billing Manager or Revenue Cycle Leadership Team.
• Identify and initiate performance improvement projects and follow through in the completion of the projects to result in operational efficiencies and revenue cycle excellence.