Navigant Consulting Inc Medical Coding Specialist- Outpatient Surgery - Health Systems Solutions - Remote Location in BURLINGTON, Massachusetts

Health System Solutions (HSS) is a newly formed Joint Venture between Navigant Consulting, Inc. and Baptist Health South Florida (BHSF). Health System Solutions will provide revenue cycle management services initially to BHSF and then expand to other providers. This new company combines Baptist Health South Florida’s highly skilled staff and Navigant’s industry-leading RCM expertise, innovative processes and technology tools.

The combination of Navigant’s strong market position in outsourced revenue cycle management and Baptist Health South Florida, as an internationally renowned center of excellence for healthcare services, creates an exceptionally strong company to compete in the ever-changing healthcare services industry. Health Systems Solutions will help healthcare services providers defend, protect, and create value in the midst of transformational change or when facing significant regulatory or legal pressures.

  • Provide on-going evaluation and monitoring towards the correct assignment of ICD9CM and ICD10CM diagnoses, HCPCS and CPT4 procedures resulting in appropriate CPT assignment for proper reimbursement, data quality, patient care and reporting in accordance with coding, state and federal guidelines while under the direction of the Coding Education Manager

  • Assist trainees in the program minimum quality and productivity standards are met upon completion of the program to transfer trainee into Coding Specialist position

  • Supervise and provide mentorship to inpatient coding trainee

  • Serve as one-one supervisor to the coding staff in the H.I.M. coding career ladder program providing performance feedback through training; guiding them in their early daily activities

  • Participate in the selection process, counsel, evaluate, and reward of personnel in the H.I.M. coding career ladder program to ensure high level of coding quality and productivity

  • Develop and coordinate on the job training of employees entering the H.I.M. coding career ladder program instructing them on systems

  • Monitor overall compliance of abstracted data reported to state and federal agencies for local and national data comparisons

  • Review quality of work to ensure accurate coding for appropriate reimbursement

  • Monitor staff productivity to ensure efficiency of coding and abstracting of medical records

  • Coordinates H.I.M. coding career ladder program staff assignment and schedules to provide efficient coverage of department functions as well as optimal utilization of available resources

  • Assist in developing and providing individual and group education for coding staff in the H.I.M. coding career ladder program to improve coding accuracy and productivity in preparation to join the coding specialist staff

  • Assist in preparing and providing training to the coding specialist staff on quarterly and annual regulatory coding updates

  • Work with AR Manager to ensure appropriate training is provided to gain required knowledge and be successful as a coding specialist

  • High School Diploma

  • AHIIMA Coding Certificate

  • Must have CCS from AHIMA within 2 years of employment

  • Minimum 2 years of experience

  • Competent in Word and Excel

  • Self-motivator with ability to work independently and productively in a remote environment

  • Knowledge of encoder system, outpatient prospective payment system (OPPS); APCs/EAPGs and Ambulatory Surgical Center payment system (ASC)

  • Knowledge and thorough understanding of National and Local Coverage Determination, NCD and LCD, Policies

  • Communicate effectively with coworkers, management staff and physicians

  • Required CCS certification within 2 years of employment, if not CCS certified

  • Code Outpatient Surgery and Observation records for the classification of all diseases, injuries, procedures, and operations using the ICD10CM and CPT4 coding system

  • Ensure compliance of coding rules and regulations according to Regulatory Agencies (CMS, OIG)

  • Work as a team to meet departmental goals and AR goals

  • Abstract prescribed data elements from the medical records

  • Responsible for validating, modifying, adding/deleting of principal diagnosis, secondary diagnoses, and procedures codes as recommended by the Natural Language Processing (NLP) engine according to principles of ICD10CM and CPT4 coding system following Official Coding Guidelines for consistency and optimal reimbursement with at least 95% coding accuracy rate according to national standards and reaching towards desired goals of 98%

  • Validate, modify, add/delete/abstract information attained from the medical records into computer system: i.e., disease and operation codes, surgeon and date of surgery with minimum accuracy rate of 98%

  • Code and abstract according to productivity performance standards and goals set by department of 6 Outpatient Surgery/Observation encounters an hour

  • Query physicians when there is conflicting, ambiguous or incomplete documentation in the medical record

  • Resolve coding system edits before finalizing coded account for appropriate coding and reimbursement following Official Guidelines for Coding and Reporting, HCPCS coding clinics and CPT Assistant and in compliance with state and federal regulations

  • Plan, organize and prioritize of daily work ensuring daily TAT goals are met as well as managing the SDS and Virtual worklists daily ensuring encounters are coded timely to meet weekly account receivable goals

  • researching Coding Clinic, CPT Assistant and HCPCS Coding clinics as references for accurate reporting of procedures

  • Identify and report inaccuracies found in the coding software to HIM Management and/or generating Trace reports for escalation and resolution

  • Maintain CEUs and updates coding knowledge through reading of coding articles/newsletters and attending seminars and meetings as well as completing assigned AHIMA CATS modules

  • Abide by the Standards of Ethical Coding as set forth by the American Health Information Management Association and adheres to Official Guidelines for Coding and Reporting

Health System Solutions is an Equal Employment Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, citizenship status, military status, protected veteran status, religion, creed, physical or mental disability, medical condition, marital status, sex, sexual orientation, gender, gender identity or expression, age, genetic information, or any other basis protected by law, ordinance, or regulation.

Health System Solutions will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of applicable law or ordinance including the Fair Chance Ordinance of Los Angeles and San Francisco.