Remote Inpatient Coding Specialist
Aspirion s Inpatient Coding Specialist, acting as an extension of a hospital s business office, advocates for reimbursement for services provided by the hospital. Accountable for carrying an extensive caseload and responsible for review and analysis of complex coding issues. Review and analyze medical records and coding guidelines to formulate coding arguments for appeals and/or coding guidance for potential rebills. Maintain a working knowledge and stay abreast of ICD-10-CM and ICD-10-PCS, CPT-4 coding principles, modifier usage, medical terminology, governmental regulations, protocols and third party payer requirements pertaining to billing, coding and documentation.
DUTIES AND RESPONSIBILIITES:
- Maintains extensive caseload of coding denials.
- Reviews insurance coding related denials, including but not limited to, DRG downgrade, DRG Validation, Clinical Validation, diagnosis codes not supported, incorrect or invalid CPT/HCPCS Codes, Modifier issues, and/or general coding error denials.
- Responsible for reviewing assigned diagnostic and procedural codes against patient charts using ICD-10-CM and ICD-10-PCS or any other designated coding classification system in accordance with coding rules and regulations.
- Reviews medical records for the determination of accurate assignment of all documented diagnoses and procedures.
- Complies with timely filing deadlines for coding reviews.
- Assists with short-notice timely filing deadlines for accounts with coding issues.
- Formulates strategy for prioritizing cases and maintains aging within appropriate ranges with minimal direction or intervention from Managing Attorney.
- Identifies issues and trends for reporting to the clients.
- Research coding issues and provide extensive feedback via memorandums, articles, and training programs.
- Formulates client friendly emails for Client Manager.
- Contacts Insurance Carriers to resolve claim issues.
- Prepares and submits appropriate appeals.
- Maintains working knowledge of and adheres to assigned clients process and protocols.
- Maintains working knowledge of and complies with applicable insurance carriers timely filing deadlines, claims submission processes, and appeal processes.
- Maintains payer portal access and utilizes said portal to assist the team at large.
- Escalates timely filing requests to Client Manager.
- Escalates information requests to Client Manager.
- Reviews extensive, high dollar claims and collaborates with Management in addressing the coding components of said claims.
- Answers questions pertaining to coding analysis of accounts.
- Advises Aspirion attorneys and employees about coding analysis.
- Compiles training material and educational sessions associated with coding related topics and present such educational materials to Aspirion attorneys or other Aspirion team members.
- Awareness of and adherence to Aspirion policy and procedures.
- Researches complex issues.
- Adheres to HIPAA compliance rules and regulations.
- Responsible for reporting any violations relating to company policy protocol.
- Responsible for escalating IT issues to Managing Attorney.
- Performs additional duties as assigned.
EDUCATION AND EXPERIENCE QUALIFICATIONS:
- Inpatient Coding Certification is required.
- CDI experience or CCDS certificate is preferred.
- Minimum of one (1) year of experience in revenue cycle management with a proven ability to consistently carry a robust caseload.
- Working knowledge of pertinent state and federal statutes.
- Working knowledge of Uniform Hospital Discharge Data Set (UHDDS) definitions, ICD-10 CM and ICD-10 PCS Official Guidelines for Coding and Reporting, American Hospital Association (AHA) Coding Clinics and/or any CPT/HCPCS coding guidelines.
- Experience in client systems.
- Health Care Plan (Medical, Dental & Vision)
- Retirement Plan (401k, IRA)
- Life Insurance (Basic, Voluntary & AD&D)
- Paid Time Off (Vacation, Sick & Public Holidays)
- Short Term & Long Term Disability
- Training & Development
- Work From Home
Equal Opportunity Employer/Drug-Free Workplace: Aspirion is an Equal Employment Opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, age, sex, pregnancy, religion, national origin, ancestry, medical condition, marital status, gender identity citizenship status, veteran status, disability or veteran status. Aspirion has a Drug-Free Workplace Policy in effect that is strictly adhered to.
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