With supervision, directly supports the following responsibilities of the Enterprise-Wide Coding team: maintain and update enterprise-wide and department coding policies and procedures for PHS; monitor compliance to all external regulatory agency coding rules and regulations; coordinate internal and external enterprise-wide coding audits for all areas within PHS conducting coding; summarize and track internal and external audit results for all of PHS; coordinate and track enterprise-wide training of all PHS coding, audit, physician and clinician personnel; support via tracking the enterprise-wide corrective action plans for coding, audit, physician and clinician personnel identified as low performers; perform medical record and billing reviews of denied and appealed claims with assistance of coder and clinical auditors; compile and analyze Enterprise-Wide Coding scorecard metrics for coding related denials and appeals and overall coding accuracy results based on both internal and external audits; research regulatory agency regulations; correct patient accounts based on internal and external audit findings.
Type of Opportunity: Full time Job Exempt: No Job is based: Remote Workers New Mexico Work
Days
Liaison to the Manager, Information Services, Finance/Patient Financial Services, all hospitals, all PMG sites, PHP, Home Health, Albuquerque Ambulance, Compliance and all ancillary departments in addressing functional coding, auditing, compliance and training issues and problems. Responsible for maintaining accurate, complete and timely documentation in either electronic or hard copy form. Maintains and disseminates up-to-date technical knowledge of legal and regulatory information from all appropriate jurisdictions concerning the given business area.
This includes but is not limited to all ICD-9, CPT-4, HCPCS and APC updates and changes. Researches coding, billing and charging compliance issues, recommends and implements corrective action plans that assure compliance with regulatory agencies where appropriate. Responds to inquiries and requests daily regarding coding and auditing issues and problems and ad-hoc analysis for all PHS management.
Gathers and analyzes information and provides recommendations to address and resolve business issues for a specific business group. Responds to client problems and inquiries via the telephone and e-mail. Maintains up-to-date working knowledge of all PHS coding and auditing IT applications.
Researches and investigates external and internal customer concerns regarding patient care and/or billing of patient care. Analyzes and summarizes data from medical record and account audits and communicate results and findings to management. Documents via information systems the responses and resolutions to both internal and external customer inquiries and issues to ensure high quality and standardized responses as well as tracking and reporting capability.
Provide assistance in audit research and documentation.
High school diploma/GED required. One year healthcare clinical, coding, auditing, compliance or patient financial services related experience. Excellent written and verbal communication skills.
Detail and results oriented. Ability to work independently. Medical terminology, ICD-9/10, CPT-4 and HCPCS knowledge required.
All benefits-eligible Presbyterian employees receive a comprehensive benefits package that includes medical, dental, vision, short-term and long-term disability, group term life insurance and other optional voluntary benefits. Wellness Presbyterian's Employee Wellness rewards program is designed to provide you with engaging opportunities to enhance your health and activate your well-being. Earn gift cards and more by taking an active role in our personal well-being by participating in wellness activities like wellness challenges, webinar, preventive screening and more.
Why work at Presbyterian? As an organization, we are committed to improving the health of our communities. From hosting growers' markets to partnering with local communities, Presbyterian is taking active steps to improve the health of New Mexicans.
About Presbyterian Healthcare Services Presbyterian exists to improve the health of patients, members, and the communities we serve. We are locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 14,000 employees - including more than 1600 providers and nearly 4,700 nurses.
Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans. AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.
We're Determined to Support New Mexico's Well-Being | Presbyterian Healthcare Services