CLINICAL DATA SPECIALIST- CODER/UTIL MGMT
Location: Seattle Washington
Description: University of Washington is currently interviewing CLINICAL DATA SPECIALIST- CODER/UTIL MGMT right now, this career will be placed in Washington. Detailed specification about this career opportunity kindly read the description below. Req #: 98017 Department: HIM CODING Job Location: Harborview Medical Center Job Location Detail: 401 Broadway Posting Date: 11/07/2013 Closing Info: Open Until Filled Salary: 3784.00 to 5832.00 per month Union Position: Yes This classification is governed by a negotiated labor contract and is subject to union shop provisions. For more information about union shop provisions, visit Union Information As the region's only Level I Trauma center, Harborview Medical Center (HMC) is well known for ! innovations and excellence in trauma care and its centers of e! mphasis: Trauma, Burn, Neurosciences, AIDS/STD CARER, and mentally-and medically- vulnerable populations. In addition to the centers of emphasis, HMC serves a mission population for King County. Harborview employees are committed to the vital role the institution plays in the immediate community, as well as the entire Northwest region.
HMC is owned by King County and managed by the University of Washington (UW) and serves as a training site for UW’s School of Medicine. The UW is proud to be one of the nation’s premier educational and research institutions. Our people are the most important asset in our pursuit of achieving excellence in education, research, and community service. Our staff not only enjoys outstanding benefits and professional growth opportunities, but also an environment noted for diversity, community involvement, intellectual excitement, artistic pursuits, and natural beauty.
Harborview Medical Center has an exciting opportunity! for a CLINICAL DATA SPECIALIST - CODER / UTILIZATION MANAGEMENT . This position provides opportunities to work in a fast-paced, challenging, diverse and rewarding environment. As an employee you will enjoy generous benefits and work/life programs. For detailed information on Benefits for this position, click here.
Under general direction CLINICAL DATA SPECIALIST - CODER / UTILIZATION MANAGEMENT , analyzes medical records to assign ICD-9-CM, CPT, E&M, HCPCS codes to assure optimal reimbursement. Utilizes classification systems to support the prospective payment systems such as Ambulatory Procedure Classifications, Diagnostic Related Groups and Consolidated Decision Support Systems. Applies appropriate InterQual criteria while reviewing chart documentation to determine inpatient, observation or Ambulatory Surgery status of patient records, verify treatment and length of stay, analyze criteria to ensure correct code assignment, DRG, and reimbursement in compliance wi! th federal guidelines. Possesses a high level of knowledge of Anatomy a! nd medical terminology in order to code the highly complex records of a Level I trauma center.
The CLINICAL DATA SPECIALIST - CODER / UTILIZATION MANAGEMENT will: 1. Assign and report coding and final DRG or APC assignment to demonstrate transfer or discharge of the patient to ensure appropriate reimbursement for the facility. 2. Work with health information management-related applications (deficiency tracking, chart locator, abstractor, encoder, registration, master patient index, registries, clinical data repository, and quality management) to gather clinical data to support the selection of codes.
3. Review patient records using InterQual inpatient or observation criteria to determine whether a patient was admitted appropriately to the facility. Report these findings to Utilization Management and Patient Financial Services to help assist with procedures to admit patients appropriately and bill appropriately as well. 4.
Review patient records up! on admission to the Rehabilitation Unit; assign codes to each record to assure proper CMG assignment and appropriate reimbursement to the facility for Medicare rehab patients. 5. Analyze clinical data, interpret information, and present the data for multidisciplinary team. 6.
Assign ICD-9-CM codes to complex trauma diagnoses and procedures in an integrated system of inpatient, outpatient, ambulatory records, and mental health records. 7. Abstract patient data to ensure data integrity, accurate reimbursement, proper case mix and hospital decision support. 8.
Utilize classification systems such as Diagnostic and Statistical Manual (DSM), Systematized Nomenclature for Medicine (SNOMED), morphology coding, HCPCS II, Evaluation and Management codes, ICD-9-CM and CPT as appropriate code selection for Consolidated Decision Support, reimbursement for the facility by assigning the proper APC or DRG. Also to facilitate proper billing for physician fees. 9. Review pa! tient records such as nursing documentation and treatment records, to d! etermine the charges for that visit.
Complete a professional fee sheet for each record reviewed utilizing InterQual criteria to assure proper billing of each record. 10. Interpret data for reimbursement applications. 11.
Enter and verify all coded and demographic data into the encoder/abstracting system to facility multi-disciplinary decision support and data retrieval. 12. Participate in internal and external review and audits of patient records. 13.
Participate with auditors in onsite prebilling, quarterly audits to ensure accuracy of coded data and DRG assignment to promote continual quality improvement. 14. Design and implement data collection instruments for reporting of documentation, coding and billing findings. 15.
Perform analysis of claims prior to billing to assure outpatient bills are sent out without any CCI edits unresolved. 16. Investigates and researches billing and coding issues as related to inquiries, complaints, or aud! it results. 17.
Share information about data collection models such as prospective payment classification systems and compliance programs such as Health Insurance Portability and Accountability Act (HIPAA) and new legislation impacting the Academic Medical Center. 18. Serves as a resource for current coding, billing, and regulatory guidelines. 19.
Interpret reimbursement reports and recommend proactive responses to problems identified. 20. Perform audits to verify accuracy, integrity and quality of data. 21.
Evaluate accuracy and completeness of supporting documentation. 22. Prepare reports for data information requests from the abstracting/encoding system. 23.
Assist in development of Policy, Procedures and database collection. 24. Review claims for accuracy of ICD-9-CM, CPT, E/M, HCPCS coding and the proper use of modifiers. 25.
Provide support to medical center physicians and staff for documentation and coding review questions! . 26. Produce outcome statistics and reports as requested. 27.
! Abstract and report clinical pathway data to facilitate internal decision support and tracking. 28. Perform proactive techniques to verify accuracy, integrity, and quality of data before finalization of bill processing. 29.
Identify documentation issues in patient records. Query physician for clarification of documentation issue and request record addendum to the record to make that clarification. 30. Assist with development of coding manuals, standards, and policies and procedures.
31. Assist in the design of quality assurances studies, abstract data for these studies and report data for these studies as requested. 32. Communicate with providers who are clarifying documentation for such areas such as problem list, reason for visit, care plan, diagnoses, procedures and pharmaceuticals.
33. May assist or coordinate the work assignments with other staff members. 34. May assist with the training of new employees.
35. Perform special project! s as assigned. 36. Assignment of ICD-9-CM, CPT, HCPCS, E/M codes along with assignment of modifiers.
37. Apply InterQual criteria to inpatient and observation records. 38. Abstract data from patient record into computer system.
39. Appropriately complete fee sheets for appropriate billing. 40. Understand and have the ability to review records based on CCI edit criteria.
41. Possess a high level of knowledge of Anatomy and medical terminology REQUIREMENTS: Certified as a Registered Health Information Technician (RHIT) AND two years of experience in health information management OR equivalent education/experience. DESIRED: Two years experience in ICD-9-CM, CPT, E/M coding Prefer one year coding experience at a level I trauma center, to include burns, multiple trauma, Neuro/Ortho surgical catastrophic injury related diseases and/or medical complications using a broad knowledge of coding guidelines and standards. Experience or education in utilization! management and InterQual criteria, a plus.
Experience with he! alth care billing, coding, and compliance, a plus. Comprehensive knowledge of Federal health care billing rules and regulations. Experience with E&M, CPT, ICD-9 and HCPCS coding. Proficiency with PowerPoint, MS Word and Excel.
Excellent and effective oral and written communication skills. Self-motivated, detail-oriented and highly organized skill set. The University of Washington is a leader in environmental stewardship & sustainability, and committed to becoming climate neutral. The University of Washington is an equal opportunity, affirmative action employer.
To request disability accommodation in the application process, contact the Disability Services Office at 206-543-6450 / 206-543-6452 (tty) or dso@uw.edu. https://uwhires.admin.washington.edu/eng/candidates/default.cfm?szCategory=jobprofile&szOrderID=98017&szCandidateID=0&szSearchWords=&szReturnToSearch=1-- >
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If you were eligible to this career, please email us your resume, with ! salary requirements and a resume to University of Washington.
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This career starts available on: Thu, 28 Nov 2013 07:16:04 GMT