Coding Account Resolution Specialist

Position Title:

Department:

Job Description:

This position may be performed remotely from the following locations within the United States of America:  Arkansas,  Kansas, Missouri, Oklahoma, and Texas. Please only apply if you live and work full-time in one of the states listed above or plan to relocate to one of these states before starting your employment with OU Health.  State locations and specifics are subject to change as our hiring requirements shift. 

**Ideal candidate will have same day surgery and emergency department experience**

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.