What are the responsibilities and job description for the Coding Quality Analyst position at Priority Health?
Job Summary
Acts as a liaison between physician practices, rehab services, professional billing office, coding, payer relations, compliance and revenue management operations of patient financial services and Corewell Health. Provides assistance to management and employees. Conducts coding quality reviews for the coding department, rehab services and physician practices.
Essential Functions
Required:
As a team member at Corewell Health, you will play an essential role in delivering personalized health care to our patients, members and our communities. We are committed to cultivating and investing in YOU. Our top-notch teams are comprised of collaborators, leaders and innovators that continue to build on one shared mission statement - to improve health, instill humanity and inspire hope. Join a nationally recognized health system with an ambitious vision of continued advancement and excellence.
How Corewell Health cares for you
SITE - Priority Health - 1239 E Beltline Ave NE - Grand Rapids
Department Name
Medical Code Review - PH Managed Benefits
Employment Type
Full time
Shift
Day (United States of America)
Weekly Scheduled Hours
40
Hours of Work
8 a.m. to 5 p.m.
Days Worked
Monday to Friday
Weekend Frequency
N/A
CURRENT COREWELL HEALTH TEAM MEMBERS – Please apply through Find Jobs from your Workday team member account. This career site is for Non-Corewell Health team members only.
Corewell Health is committed to providing a safe environment for our team members, patients, visitors, and community. We require a drug-free workplace and require team members to comply with the MMR, Varicella, Tdap, and Influenza vaccine requirement if in an on-site or hybrid workplace category. We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process, to perform the essential functions of a job, or to enjoy equal benefits and privileges of employment due to a disability, pregnancy, or sincerely held religious belief.
Corewell Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, gender, pregnancy, sexual orientation, gender identity or expression, veteran status, or any other legally protected category.
An interconnected, collaborative culture where all are encouraged to bring their whole selves to work, is vital to the health of our organization. As a health system, we advocate for equity as we care for our patients, our communities, and each other. From workshops that develop cultural intelligence, to our inclusion resource groups for people to find community and empowerment at work, we are dedicated to ongoing resources that advance our values of diversity, equity, and inclusion in all that we do. We invite those that share in our commitment to join our team.
You may request assistance in completing the application process by calling 616.486.7447.
Acts as a liaison between physician practices, rehab services, professional billing office, coding, payer relations, compliance and revenue management operations of patient financial services and Corewell Health. Provides assistance to management and employees. Conducts coding quality reviews for the coding department, rehab services and physician practices.
Essential Functions
- Meets with providers and coding employees regularly on billing, coding and reimbursement issues applicable to their specialty.
- Reviews monthly reporting from billing system with a focus on revenue cycle metrics, unbilled accounts, and adequate documentation.
- Acts as a liaison between the Coding department and Spectrum Health to enhance educational awareness of coding and documentation. Participates and initiates process and quality improvement activities.
- Reviews coding patterns/trends and provides ongoing consultation to providers regarding coding and documentation issues.
- Proactively identifies and communicates problems and opportunities; actively recommends and implements solutions or process improvements.
- Presents information to physicians, administrators and other institutional leadership.
- Acts as an expert resource for administrators and physicians in regulatory, coding, billing compliance and financial functions.
- Processing pended claims and provider appeals, which consists of reviewing medical records and using various coding resources to confirm correct coding.
Required:
- Bachelor's Degree accounting, finance, health care administration, or related field or equivalent combination of education and experience
- 2 years of relevant experience progressive experience in various hospital functions (e.g., professional/facility coding, reimbursement, billing, and/or chargemaster maintenance
- CRT-Registered Health Information Administrator (RHIA) - AHIMA American Health Information Management Association Upon Hire required Or
- CRT-Registered Health Information Technician (RHIT) - AAPC American Academy of Professional Coders Upon Hire required Or
- CRT-Coding Specialist (CCS) - AHIMA American Health Information Management Association Upon Hire required Or
- CRT-Professional Coder - AAPC American Academy of Professional Coders Upon Hire required
- Knowledge of CPT, HCPCS, CMS claim formats (1450 and HCFA 1500)
- knowledge of with Microsoft (Word, Excel, Visio, OneNote, etc.)
As a team member at Corewell Health, you will play an essential role in delivering personalized health care to our patients, members and our communities. We are committed to cultivating and investing in YOU. Our top-notch teams are comprised of collaborators, leaders and innovators that continue to build on one shared mission statement - to improve health, instill humanity and inspire hope. Join a nationally recognized health system with an ambitious vision of continued advancement and excellence.
How Corewell Health cares for you
- Comprehensive benefits package to meet your financial, health, and work/life balance goals. Learn more here.
- On-demand pay program powered by Payactiv
- Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more!
- Optional identity theft protection, home and auto insurance
- Traditional and Roth retirement options with service contribution and match savings
- Eligibility for benefits is determined by employment type and status
SITE - Priority Health - 1239 E Beltline Ave NE - Grand Rapids
Department Name
Medical Code Review - PH Managed Benefits
Employment Type
Full time
Shift
Day (United States of America)
Weekly Scheduled Hours
40
Hours of Work
8 a.m. to 5 p.m.
Days Worked
Monday to Friday
Weekend Frequency
N/A
CURRENT COREWELL HEALTH TEAM MEMBERS – Please apply through Find Jobs from your Workday team member account. This career site is for Non-Corewell Health team members only.
Corewell Health is committed to providing a safe environment for our team members, patients, visitors, and community. We require a drug-free workplace and require team members to comply with the MMR, Varicella, Tdap, and Influenza vaccine requirement if in an on-site or hybrid workplace category. We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process, to perform the essential functions of a job, or to enjoy equal benefits and privileges of employment due to a disability, pregnancy, or sincerely held religious belief.
Corewell Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, gender, pregnancy, sexual orientation, gender identity or expression, veteran status, or any other legally protected category.
An interconnected, collaborative culture where all are encouraged to bring their whole selves to work, is vital to the health of our organization. As a health system, we advocate for equity as we care for our patients, our communities, and each other. From workshops that develop cultural intelligence, to our inclusion resource groups for people to find community and empowerment at work, we are dedicated to ongoing resources that advance our values of diversity, equity, and inclusion in all that we do. We invite those that share in our commitment to join our team.
You may request assistance in completing the application process by calling 616.486.7447.