This position is responsible for providing support to the organizations responses to audit requests for patient medical records. These requests can come from multiple external payors/audits including the RAC (Recovery Audit Contractor) program, FIs (Fiscal Intermediaries), MACs (Medicare Administrative Contractors), etc. This position manages the retrieval of patient records from facilities across the system and ensures complete medical records are received on a timely basis by the payor/auditor, evaluating any coding related denials received and facilitating timely appeals process using either external or internal resources. Responsibilities also include entering and/or managing the data as appropriate in the tracking database; assisting in the evaluation of requests, denial trends and the success of the appeal process; recommending, developing and/or coordinating appropriate education to address coding and billing trends in order to prevent further claims denials.
Tracks and monitors all responses to external payors/auditors for patient medical record requests for the company. This includes managing the initial request as well as timely appeals. Acts as a liaison between facilities and the external requestor to ensure all medical record are complete and are received by the external requestor in a timely manner and within established due dates. Coordinates with external consultants to manage outside counsel involved in higher level appeals of RAC determinations.
Manages the denial management process for coding related denials, evaluating claims deemed inappropriately paid by the external payor/auditor and determining the need for appeal. Works with facility and applies relevant coding and billing guidelines to make the determination for appeal.
Assists in tracking, monitoring, and reporting RAC coding related recoupments and payments following appeals and the effectiveness of the appeal process including denial reporting. Identifies coding trends and the type of claims being reviewed by the external payors/auditors, the status and success of all appeals.
Assists with monitoring related resources and websites to identify current external payor/auditor strategies and focus areas and ensure that up-to-date strategies are in place at both a system and facility level. Suggests and coordinates focus areas for audits and education to address specific coding and billing regulations and prevent further claims denials.
Requires a level of education as normally demonstrated by a bachelors degree in Health Information Management and current continuing education.
Requires Certified Coding Specialist (CCS) or Certified Professional Coder (CPC) or Certified Coding Specialist-Physician (CCS-P) or Registered Health Information Technologist (RHIT) or Registered Health Information Administration (RHIA) in an active status with the American Health Information Management Association (AHIMA) or American Academy of Professional Coders (AAPC).
Requires proficiency typically obtained with five or more years of health care coding experience. Must demonstrate a proficiency in hospital and/or multiple physician specialty coding as normally obtained through five years of current and progressively responsible coding experience. Must possess a thorough knowledge of ICD/DRG coding and/or CPT coding principles, and the recommended American Health Information Management Association coding competencies. Requires an in-depth knowledge of medical terminology, anatomy and physiology, plus a thorough understanding of the content of the clinical record and an extensive knowledge of all coding conventions and reimbursement guidelines, across all services lines, LCD/NCDs and MAC/FIs. Extensive critical and analytical thinking skills required. Ability to organize workload to meet deadlines, and maintain confidentiality of all work information. Ability to research, interpret and develop recommendations. Excellent written and oral communication skills are required, as well as effective human relations and leadership skills for building and maintaining a working relationship with all levels of staff, physicians, and other contacts.
Must consistently demonstrate the ability to understand the Medicare Prospective Payment System, and the clinical coding data base and indices, and must be familiar with coding and abstracting software, as well as common office software and the electronic medical records software.
Additional related education and/or experience preferred.
Internal Number: 258488
About Banner Health
You want to change the health care industry – one life at a time. You belong here. You’re excited to be part of the dramatic changes happening in the health care field. In fact, you thrive on change. But you also understand that excellent, compassionate patient care is the true measure of the success of these changes. You belong at Banner Health. Our award-winning, comprehensive health system includes 23 hospitals in seven western states, primary care health centers, research centers, labs, a network of physician practices and much more. Throughout our system, skilled, compassionate professionals use the latest technology to change the way care is provided. If you’re looking to be a key contributor to a forward-looking organization, you’ll experience a wide variety of professional advantages: •Our vision for changing the future of health care gives you the opportunity to leverage your abilities to achieve something historic. •Our expansive system offers you an unmatched variety of clinical settings – from large urban trauma center to small rural hospital, ambulatory to home health. Our system also includes hospitals specializing in cancer, heart health and pediatrics. •Our many loc...ations also translate into a broad selection of exciting and rewarding lifestyle options – from the big city to the wide-open spaces. •Our commitment to healthcare innovation means you always have the latest technologies at your fingertips to help you provide the finest care possible. •The size, success and growth of our system provide you with the stability and options to pursue your desired career path. •Our competitive compensation and comprehensive benefits offer you options to complement your unique needs.