Creates, conducts and validates routine and focused coding audits. Identifies risks, develops and follows-up on action plans and provides specific coding compliance education. Reviews the quality of medical records and billing documentation. Complies with Medicare and Medicaid regulations, HIPAA regulations and Recovery Audit Programs focusing on internal and external risk assessments.
This position is exempt from Career Service under the CCHHS Personnel Rules.
Utilizes coding compliance knowledge of CPT-4, HCPCS, Revenue, ICD10-CM and PCS, E&M, DRG, APC, etc. to identify inefficient documentation and coding quality deficits
Develops and performs routine, probe, validation and focused audits and risk; audits any identified organization risks when required
Generates reports on audits performed
Collaborates with staff to design effective action plans and target dates; follows through on critical timelines to ensure implementation; performs re-audits as needed to verify ongoing compliance
Cultivates a shared vision for the department that is consistent with the organization's vision and strategic initiatives by communicating and implementing department plans
Monitors employee productivity and addresses performance issues
Assists in developing key performance indicators for overall coding accuracy
Provides cross training to optimize daily operations and to meet the needs of the organization
Provides ongoing training and education for staff development
Participates in hospital-wide activities promoting health information and privacy and security education
Maintains confidentiality of Protected Health Information (PHI)
Attends departmental and Hospital training in-service programs; ensures the attendance of all staff as required
Prepares guideline documents and develops monitoring tools and other resources to assist in ensuring an effective Compliance Program
Actively develops and participates in training activities related to coding
Reviews and validates provider billing coding methods
Provides recommendations for development of standards
Assists in the resolution of provider reimbursement configuration or claim payment issues as need
Provides technical guidance for configuring coding to the Business Department
Meets the standard for compliance of continuing education as defined by AHIMA or other licensing/certification agency, if applicable
Researches federal and state regulations on coding guidelines for updates or changes
May be required to work flexible hours, including weekends
Performs other duties as assigned
Bachelor's Degree in Health Information Management from an accredited college or university
Registered Health Information Technician (RHIT) or Registered Health Information Administrator (RHIA)
Three (3) years of experience with Physician-based coding and Inpatient and Outpatient coding
Two (2) years of experience with Coding Auditing
Certified Coding Specialist - Physician-based (CCS-P), Certified Professional Coder (CPC), or Certified Coding Specialist (CCS)
Five (5) years of experience with Physician-based coding and Inpatient and Outpatient coding
Prior experience implementing training and quality assurance programs
Experienced coder using one or more of the following: CPT-4, HCPCS, Revenue, , ICD10-CM and PCS, E&M, DRG, APC, etc.
Experience working with electronic records systems and encoders
Knowledge, Skills, Abilities and Other Characteristics
Extensive working knowledge and understanding of healthcare industry coding theory, rule and standards (CPT-4, HCPCS, Revenue, ICD10-CM and PCS, E&M, DRG, APC, etc.)
Knowledge of federal & state regulations on coding guidelines
Knowledge and understanding of medical terminology, body systems/anatomy, physiology and concepts of disease
Knowledge and application of electronic records systems and encoders
Excellent verbal and written communication skills necessary to communicate with all levels of staff and a patient population composed of diverse cultures and age groups
Demonstrate analytical and organizational, problem-solving, critical thinking, and conflict management/resolution skills
Demonstrates good computer and typing skills using Microsoft Office Suite (Word & Excel)
Ability to review data from multiple sources and aggregate to meaningful, actionable information for use within and outside the coding department
Ability to prioritize, plan, and organize projects and tasks
Ability to multi-task and meet deadlines in a fast paced and stressful environment
Ability to work flexible hours, including weekends
Ability to adhere to department policies and standards utilizing best practices
Ability to maintain a high level of discretion and maintain confidentiality
Ability to maintain a professional demeanor and composure when challenged
When applying for employment with the Cook County Health & Hospitals System, preference is given to honorably discharged Veterans who have served in the Armed Forces of the United States for not less than 6 months of continuous service.
To take advantage of this preference a Veteran must :
Meet the minimum qualifications for the position.
Identify self as a Veteran on the employment application by answering yes to the question by answering yes to the question, "Are you a Military Veteran?"
Attach a copy of their DD 214, DD 215 or NGB 22 (Notice of Separation at time of application filing. Please note: If you have multiple DD214s, 215s, or NGB 22S, Please submit the one with the latest date. Coast Guard must submit a certified copy of the military separation from either the Department of Transportation (Before 9/11) or the Department of Homeland Security (After 9/11). Discharge papers must list and Honorable Discharge Status. Discharge papers not listing an Honorable Discharge Status are not acceptable
A copy of a valid State ID Card or Driver's License which identifies the holder of the ID as a Veteran, may also be attached to the application at time of filing.
If items are not attached, you will not be eligible for Veteran Preference
Medical, Dental, and Vision Coverage
Basic Term Life Insurance
Deferred Compensation Program
Paid Holidays, Vacation, and Sick Time
You may also qualify for the Public Service Loan Forgiveness Program (PSLF)
100% Tuition Reimbursement for nursing-related programs
VETERANS MUST PROVIDE ORIGINAL APPLICABLE DISCHARGE PAPERS OR APPLICABLE STATE ID CARD OR DRIVER'S LICENSE AT TIME OF INTERVIEW
MUST MEET REQUIRED QUALIFICATIONS AT TIME OF APPLICATION
*Degrees awarded outside the United States with the exception of those awarded in one of the United States' territories and Canada must be credentialed by an approved U.S. credential evaluation service belonging to the National Association of Credential Evaluation Services (NACES) or the Association of International Credential Evaluators (AICE). Original credentialing documents must be presented at time of interview.
*Please note all offers of Employment are contingent upon the following conditions: satisfactory professional & employment references, healthcare and criminal background checks, appropriate licensure/certifications and the successful completion of a physical and pre-employment drug screen.
*CCHHS is strictly prohibited from conditioning, basing or knowingly prejudicing or affecting anyterm or aspect of County employment or hiring upon or because of any political reason or factor.
COOK COUNTY HEALTH AND HOSPITALS SYSTEM IS AN EQUAL OPPORTUNITY EMPLOYER
ABOUT COOK COUNTY HEALTH (CCH)
The Cook County Health’s mission is to deliver integrated health services with dignity and respect regardless of a patient’s ability to pay; foster partnerships with other health providers and communities to enhance the health of the public; and advocate for policies that promote the physical, mental and social wellbeing of the people of Cook County.
CCH is comprised of two hospitals, John H. Stroger, Jr. Hospital and Provident Hospital, a robust network of more than a dozen community health centers, the Ruth M. Rothstein CORE Center, the Community Triage Center, the Cook County Department of Public Health, Cermak Health Services, which provides health care to individuals at the Cook County Jail and the Juvenile Temporary Detention Center, and CountyCare, a Medicaid managed care health plan.
The system cares for more than 300,000 patients each year and its physicians are experts in their fields, committed to providing their patients with comprehensive, compassionate and cutting-edge care. Today, CCH is transforming the provision of health care in Cook County by promoting community-based primary and preventive care, growing an innovative, ...collaborative health plan and enhancing the patient experience.
COOK COUNTY HEALTH IS AN EQUAL OPPORTUNITY EMPLOYER
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