Overview of Responsibilities: The essential responsibility of this role is to provide clinical, coding expertise to contracted agencies of SMART Healthcare Compliance. Based on the level of the contractual agreement with the assigned agency, the Coding Auditor will make decisions as to coding based on ICD-10 coding conventions and provide to the agency appropriate recommendations as to medication profile, review H&P and referral information to ensure compliance with federal regulations.
Duties and Responsibilities:
- Completes accurate coding for assigned agencies utilizing the agency’s EMR and any “scrubbing” software to assess clinical records and ICD-10-CM, and Decision Health Coding Pro Software. Recommended to have/gain familiarity with multiple EMR software platforms.
- Resources CMS regulations, industry standards and coding convention as supported by clinical documentation.
- Utilizes clinical knowledge in assessing clinical documentation for best practice initiatives.
- Attends/participates in ongoing learning and education in ICD-10 coding, and industry and regulatory changes.
- Maintain quality of coding review with score of 90% or greater on ongoing quality audits.
- Plan, prioritize, organize and complete work to meet established objectives.
- Monitors work performance of clinicians of assigned locations, and communicates, through Sr. Director, trended performance concerns of clinicians to agency leadership.
- Maintains confidentiality of patient and agency information, adhering to HIPAA guidelines.
- Participates in and presents education sessions, mentoring or agency education sessions as required to enhance knowledge base of clinicians.
- Adheres to federal/state guidelines, rules and regulations, statutes and law.
- Utilizes time management skills to achieve daily productivity standards and documentation submission requirements.
Licenses & Certifications: Nursing clinical background required; RN/LPN preferred.
- HCS-H certification preferred but not required.
- HCS-D certification required.
Rationalization Skills: Employee demonstrates proven ability to function as remote employee with supervision and ability to maintain quality standards while achieving productivity and accuracy in work performed. Demonstrates tested quality and integrity skills. Able to make and support independent decisions related to accuracy of ICD-10-CM Coding.
Education: RN/LPN preferred; Associate degree or higher in clinical program required with formal clinical background; RN/LPN preferred. Experience: Minimum of 2 years of recent hospice coding with current certifications. Clinical home health experience preferred.
- Occasionally (up to 30%) – Standing, Bending, Squatting, Kneeling, Twisting, Lifting up to 50 lbs., Carrying up to 50 lbs.
- Frequently (31-60%) - walking.
- Continuously (61 – 100%) - Sitting.
- Visual, Hearing and Health Requirements – must be able to see computer screen for long periods of time with corrective eyewear. Must be able to hear clearly with assistance and verbalize clearly.
Technology: Must have knowledge of home health EMR software data bases. Additionally, has familiarity with Microsoft Office suite to include Word, Excel, Outlook, and Power Point spreadsheet and database software. Use of SHP, PPS Plus, Decision Health Coding Pro is a plus.
Job Type: Full-time
Pay: $70,000.00 - $76,000.00 per year
- relevant: 2 years (Required)
This Job Is Ideal for Someone Who Is:
- Dependable -- more reliable than spontaneous