Coding Integrity Analyst

Job ID

67196

Location

Aurora, Colorado

Full/Part Time

Full-Time

Regular/Temporary

Regular

Why Work at Children's....

Here, it’s different. Come join us.

Children's Hospital Colorado has defined and delivered pediatric healthcare excellence for more than 100 years.

Here, the nation’s brightest nurses, physicians, scientists, researchers, therapists and care providers are creating the future of child health. With an optimist’s outlook, a trailblazing spirit and a celebrated history, we’re making new strides every day.

We’ve been Magnet-designated three times by the American Nurses Credentialing Center and are consistently recognized among the nation’s top 10 pediatric hospitals by U.S. News & World Report. 

As a national leader in pediatric care, we serve children and families from all over the nation. Our System of Care includes four pediatric hospitals, 12 specialty care centers, 400 outreach clinics and 7,000 healthcare professionals representing the full spectrum of pediatric care specialties.

We need your expertise.

A career at Children's Colorado will challenge you, inspire you, and motivate you to make a difference in the life of a child. Here, it’s different. Do you have what it takes?

Additional Information

Department: Health Information Management

Hours per week: 40, eligible for benefits

Shift: 8 hours day/40 per week, shift 1st

Job Overview

Maintains coding and revenue integrity through analyzing clinical documentation, performing concurrect and retrospective audits accordance to CHCO's compliance plans and regulatory requirements utilizing ICD/PCS 10 CM and CPT coding rules and guidelines.

Responsibilities

POPULATION SPECIFIC CARE

No direct patient care.

ESSENTIAL FUNCTIONS

An employee in this position may be called upon to do any or all of the following essential functions. These examples do not include all of the functions which the employee may be expected to perform.

Evaluates and reviews claim denials and rejections pertaining to coding and medical necessity issues. When necessary assists in development and implementation of corrective action plans to prevent similar denials and rejections from recurring.

Performs second level review of encounters to verify DRG assignment for accuracy of coding prior to billing. Audits medical record documentation and charge information to identify compliance or risk areas.

Prepares written reports and maintains detailed findings of audits to Coding Manager, HIM Director, compliance and finance departments as requested.

Provides coding and guidance for non-standard documentation and billing utilizing knowledge of clinical documentation and its impact on reimbursement under statutory or regulatory requirements. Provides explanatory and reference information to internal and external customers regarding clinical documentation requiring authoritative reference information from a variety of sources.

Serves as the subject matter expert for quality and accuracy issues that may be the result of coding errors or problems (e.g. claims rejected, reimbursement/billing issues, clinical effectiveness data, etc.).

Troubleshoots assigned codes, coding documentation and related materials; identifies and resolves issues of potentially serious dimension; follows up to ensure adjustments or corrections carried out as necessary.

Utilizing financial reports, identifies accounts in multiple work queues requiring review by HIM. Through this process routes accounts to the appropriate coder, manager or performs a second level review to resolve the issue.

Acts as a liaison to Patient Financial Services, Corporate Compliance, and Revenue Integrity researching/resolving coding and revenue integrity issues through quality assurance reviews, providing education to ensure compliance with internal operational standards and statutory/regulatory requirements requirements.

Other Information

SCOPE AND LEVEL

Guidelines: Possesses and applies a broad knowledge of concepts, practices and procedures within a particular field of specialization.

Complexity: Duties and tasks are broad and complex, usually requiring a greater degree of responsibility. Procedures, methods and techniques to carry out work may not be well defined, requiring advanced knowledge in specific specialties and of the organization.

Decision Making: Has latitude in making most decisions. Decisions and recommendations are made after contemplative analysis and with independent judgment and ingenuity. May escalate the most complex and important decisions to a higher level employee, supervisor and/or manager.

Communication: Communicates explanatory and/or interpretive information relative to the organization and/or advanced knowledge of own function with team members, peers, management, clients and in some cases, the public. Uses discretion and independent judgment is exchanged, defended, gathered and/or presented. Defers to higher level team members and/or management only when necessary.

Supervision Received: Works under limited supervision and with a high degree of independence, conferring with supervisor and/or manager on unusual matters. May be assisted by lower level employees.

Qualifications

EDUCATION – Associate’s degree.

EXPERIENCE – Minimum of two years HIM experience; AHIMA coding credential

EQUIVALENCY – Related work experience may substitute for education on a year for year basis.

CERTIFICATION(S) – RHIT Reg Health Information Tech

Physical Requirements

Ability to Perform Essential Functions of the Job

Vision - Near: clear vision at 20 inches or less

Weight Lifted/Force Exerted: up to 35 pounds/16 kilos, up to 1/3 of time

Hearing: able to clearly hear details

Sit: 2/3 or more of time

Talk: able to communicate verbally

Mental/Emotional: able to work in close proximity to others and/or in a distracting environment

Mental/Emotional: able to cope with stress effectively

Hands: able to seize, hold, grasp, or otherwise work with hands

Work Environment

Mental/Emotional: able to tolerate ambiguity

Mental/Emotional: able to prioritize effectively

Mental/Emotional: may be subject to many interruptions

Office Work Environment: Regular/frequent exposure

Bloodborne Pathogen Category 2: Occasional exposure to blood/body fluid

Equal Employment Opportunity

It is our intention that all qualified applicants be given equal opportunity and that selection decisions be based on job-related factors. We do not discriminate on the basis of race, color, religion, national origin, sex, age, disability, or any other status protected by law or regulation.  Be aware that none of the questions are intended to imply illegal preferences or discrimination based on non-job-related information.

Salary Information

Annual Salary Range (Based on 40 hours worked per week): $52,123.56 to $78,185.34

Hourly Salary Range: $25.06 to $37.59

Benefits Information

As a Children’s Hospital Colorado team member, you will receive a competitive pay and benefits package designed to take care of your needs that includes base pay, incentives, paid time off, medical/dental/vision insurance, company provided life and disability insurance, 403b employer match (retirement savings), and a robust wellness program.

Salary : $25 - $38