Coding Account Resolution Specialist

Position Title:

Department:

Job Description:

General Description: The Coding Account Resolution Specialist (CARS) works outpatient coding related alerts / edits for CLI, ED, RCR accounts, predominately post initial / final coding. The CARS performs the alert / edit resolution in the applicable systems. The alerts / edits shall be worked according to the established procedures and thresholds and communicated as appropriate.

Essential Responsibilities:

Responsibilities listed in this section are core to the position.  Inability to perform these responsibilities with or without an accommodation may result in disqualification from the position. 

• Compiles daily work list from alert / edit system
• Takes action and resolves edits / alerts for the following patient types following established procedures and thresholds
  • Emergency Department (ED)
  • Recurring (RCR)
  • Clinical (CLI)
  • Same Day Surgery (SDC)
  • Observation (OBV)
• Enters detailed notes to update eRequest to provide details if the alert / edit cannot be resolved or must be re-routed to another responsible party for research / resolution
• Escalates alert /edit resolution issues as appropriate to minimize final billing delays
• Monitors the aging of accounts held by an alert / edit, prioritizes aged accounts first, and reports to leadership
• Works with team members in billing, revenue integrity and/or the Medicare Service Center to resolve alerts / edits
• Communicates coding revisions to the applicable party (e.g., CIS, lead, manager)
• Completes MOCK abstracts as necessary
• As needed, may periodically be asked to perform Coding Integrity Specialist duties
• Periodically works with their Manager to review individual work accomplishments, discuss work problems / barriers, discuss progress in mastering tasks and work processes, and discuss individual training needs and career progression
• Monitors unbilled reports (e.g., no URC, no final diagnosis) and HPF queues (e.g., retired queries, priority queues)
• Assigns, validates and / or corrects UCRs on unbilled accounts
• Routes accounts in HPF to the appropriate production coding queue
• Ensures a CIS 3-4 ID appears in HPF assignments
• Researches unbilled accounts to identify reason for coding / billing delay
• Prepares compiled reports via Meditech abstracting module upon request
• Assists with productivity tracking
• Assists with tracking education requirements
• Adheres to all applicable coding and billing regulations and guidance, including but not limited to, CMS, AHA and OUH policies and guidelines
• Meets all educational requirements as stated in Company policy
• Reviews all official data quality standards, coding guidelines, Company policies and procedures, and clinical / medical resources to assure coding knowledge and skills remain current
• Practices and adheres to the Company’s Code of Conduct philosophy
• Practices and adheres to the Company’s Mission and Values

General Responsibilities:

• Performs other duties as assigned

Minimum Qualifications:

Education: None required.  Associates or Bachelors degree in HIM/HIT preferred.

Experience:  1-year acute care outpatient coding experience required with 3 years’ healthcare experience strongly preferred.

License(s)/Certification(s)/Registration(s) Required: CPC, RHIA, RHIT and/or CCS required.

Knowledge, Skills and Abilities:

• Coding Technical Skills - ICD-10-CM, CPT / HCPCS and associated reimbursement knowledge.
• Customer Orientation - establishes and maintains long-term customer relationships, building trust and respect by consistently meeting and exceeding expectations.
• Policies and Procedures - articulates knowledge and understanding of organizational policies, procedures and systems.
• Quality Orientation - accomplishing tasks by considering all areas involved, no matter how small; showing concern for all aspects of the job; accurately checking processes and tasks; being watchful over a period.
• Building and Maintaining Strategic Working Relationships - develops collaborate relationships to facilitate the accomplishment of work goals. Possesses good interpersonal skills in building, negotiating, and maintaining crucial relationships.
• Initiative - independently takes prompt proactive steps toward problem resolution.
• Analytical Skills - effective evaluation, synthesis and use of information gathered.
• Effective Decision Making - relating and comparing; securing relevant information and identifying key issues; committing to an action after developing courses of action that take into consideration resources, constraints and organization values.
• Managing Conflict - dealing effectively with others in an antagonistic situation; using appropriate interpersonal styles and methods to reduce tension or conflict between two or more people.
• Organization - establishing courses of action to ensure that work is completed efficiently; proactively prioritizes assignments and keen ability to multi‐task.
• Communication ‐ communicates clearly, proactively and concisely with all key stakeholders.
• Customer Orientation ‐ establishes and maintains long‐term customer relationships, building trust and respect by consistently meeting and exceeding expectations.
• Work Independently - is self‐supporting; not needing to rely on others to complete a job.
• PC Skills ‐ demonstrates proficiency in Microsoft Office applications and others as required.

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OU Health is an equal opportunity employer. We offer a comprehensive benefits package, including PTO, 401(k), medical and dental plans, and many more. We know that a total benefits and compensation package, designed to meet your specific needs both inside and outside of the work environment, create peace of mind for you and your family.