CODING SPEC-CLINIC

Covenant Health is the region’s top-performing healthcare network with 10 hospitals , outpatient and specialty services , and Covenant Medical Group , our area’s fastest-growing physician practice division. Headquartered in Knoxville, Covenant Health is a community-owned integrated healthcare delivery system and the area’s largest employer. Our more than 11,000 employees, volunteers, and 1,500 affiliated physicians are dedicated to improving the quality of life for the more than two million patients and families we serve every year. Covenant Health is the only healthcare system in East Tennessee to be named a Forbes “Best Employer” seven times.

Position Summary:

This individual provides leadership, direction, and training for the coding staff. Working directly with the physicians, Manager of Corporate Coding Services, Director of Registration/Admitting, and medical staff education efforts, serves as the user advocate between Health Information Management (HIM), Clinical Effectiveness, and Registration. Other job duties include: improving health record documentation and coding accuracy, developing and updating all departmental policies and procedures relative to coding, performing quality reviews of coding/abstracting, and focusing on problem solving issues related to denials. Provides assurance that billing practices are complete, accurate, and in compliance with state and federal guidelines.

Oversees through monitoring and by reviewing and auditing the coding staff to ensure position accountabilities and performance criteria are adhered to.

Develops and maintains departmental and hospital policies and procedures and implements new policies and procedures relative to coding.

Educates and assists physicians and clarifies coding versus clinical issues.

Works closely with Registration and Business Office personnel to resolve issues related to claims, coding, pre-cert, and denials appeals, and verifies that appropriate chargemaster rates are used.

Reviews medical record documentation to ensure existing documentation supports diagnostic/procedure code billed per UB 92 or HCFA 1500 form.

Provides education to coding staff and physicians in response to regulatory changes and identified areas of deficiency.

Monitors claim rejections and systematically assesses specific types of denial as it relates to coding and documentation issues, outpatient registration, and the receipt of physician orders.

Attends meetings and provides input as it relates to coding, medical documentation, and reimbursement issues specific to medical billing and regulatory requirements.

Increases awareness of compliance as it relates to coding and documentation.

Facilitates and coordinates education of coding staff in the areas of coding, documentation, case mix, and denials.

Increases understanding of APCs, DRGs, case mix, and denials.

Educates coding staff to proper documentation necessary to support a DRG/APC/Medical Necessity/ROM/SOI.

13 Integrates documentation, coding, and proper oversight to ensure accurate reimbursement.

Reviews records to verify if the correct code has been assigned.

Assists with all insurance requested audits and provides information to supervisor related to inaccurate and/or missing documentation.

Reviews DRG/APC classifications and educates to maximize level of care assignment for increased reimbursement.

Keeps current on local, state, and federal regulations to ensure compliance.

Keeps current on coding guidelines and communicates to Health Information Manager. Implements corrective actions as indicated to minimize financial risk.

Works with Denials Elimination Group and deals with physician specific issues as it impacts denials.

Ensures LCDs/NCDs are being adhered to by admissions and hospital personnel to ensure qualifying diagnosis covers tests/procedures.

Analyzes denials and coordinates appeals.

Ensures corrective action is taken to prevent denials from reoccurring.

Follows policies, procedures, and safety standards. Completes required education assignments annually. Works toward achieving goals and objectives, and participates in quality improvement initiatives as requested.

Performs other duties as assigned.

Minimum Education:

None specified; however, must be sufficient to meet the standards for achievement of the below indicated license and/or certification as required by the issuing authority.

Minimum Experience:

Five or more (5+) years coding experience.

Licensure Requirement:

RHIA, Coding, or RHIT certification required. Registered Health Information Technologist preferred.