Covenant Health

Job Title
CODING SPEC
ID
3343757
Facility
Covenant Health Corporate
Department Name
CENTRALIZED CODING

Overview

covenant_logo

 

 

Health Information Management Coding Specialist

Full-Time, 80 Hours Per Pay Period, Day Shift

 

Covenant Health Overview:

Covenant Health is East Tennessee’s top-performing healthcare network with 10 hospitals and over 85 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, not-for-profit healthcare system and the area’s largest employer with over 11,000 employees.

 

Covenant Health is the only healthcare system in East Tennessee to be named six times by Forbes as a Best Employer. 

 

 

Position Summary: This individual provides leadership, direction, and training for the coding staff.  Working directly with the physicians, Manager of Health Information Management, 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.

 

Responsibilities

  • 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, 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 assess specific types of denial as it relates to coding and documentation issues, outpatient registration and the receipt of physician orders.
  • Attend meetings and provide input as it relates to coding, medical documentation, and reimbursement issues specific to medical billing and regulatory requirements.
  • Increase 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.
  • Increase understanding of APCs, DRGs, case mix, and denials.
  • Educate coding staff to proper documentation necessary to support a DRG/APC/Medical Necessity/ROM/SOI.
  • Works with Denials Elimination Group and deals with physician specific issues as it impacts denials.
  • Ensure LCDs/NCDs are being adhered to by admissions and hospital personnel to ensure qualifying diagnosis covers tests/procedures.
  • Analyze denials and coordinate appeals.
  • Insure corrective action is taken to prevent denials from reoccurring.

 

Qualifications

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: Coding or RHIT certification required.  Registered Health Information Technologist preferred.

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