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Employment Type:

Full time

Shift:

Description:

Remote Position

POSITION PURPOSE

Performs annual and targeted medical record audits including, but not limited to analysis of medical record documentation; validation of primary and secondary diagnoses and procedures; and ensuring proper assignment of diagnosis and procedure codes by providers. Monitors accuracy of centralized coders charge capture and coding. Partners with centralized coding and operational leadership to improve HCC, high risk scoring, along with provider and coder education. Responsible for practitioner education in areas related to coding, documentation, and compliance.

ESSENTIAL FUNCTIONS

**Responsibilities, including but not limited to** :

Educate providers on documentation guidelines, in annual sessions and individually as required.

Determine if organizational policies are current and effective.

Ensure appropriate revenue is captured; and Defend against federal and payer audits, malpractice litigation, and health plan denials

Compare evaluation and management code utilization by provider, with comparison to national benchmarking, to identify potential outliers and audit risks.** **Performs provider targeted and focused prospective and retrospective audits of documentation compared to services billed for new and established providers.

Coordinates and partners with local ministry and System Office Integrity and Compliance benchmarks and standards.

Plans, prepares, and regularly conducts audits/reviews and other compliance related projects within an area of expertise relative to a specific healthcare service line.

Acts as a technical resource for documentation, coding and billing regulations for assigned medical groups and regions.

Prepares and performs audit related educational sessions and presents those sessions in collaboration with medical group providers, division leadership, and within group settings or one-on-one.

Trains and assists in the education, audit, and development of the Centralized Coding team.

MINIMUM QUALIFICATIONS

Associate degree in Health Information Management or a related field or an equivalent combination of years of education and experience. Bachelor’s degree in Health Information Management (HIM) or related healthcare field is preferred. Must possess a comprehensive knowledge of professional coding, regulatory guidelines, and payer policies with three (3) to five (5) years of professional coding or auditing experience.

Required** **: CPC, CRC, RHIT, CDEO, or equivalent certification

Preferred:** **CPMA or CCDS-O in conjunction with CPC, RHIT, CRC or CDEO accreditation

Preferred:** **Extensive knowledge of medical data auditing, interpretation, and analysis.

Preferred:** **Four (4) to six (6) years of professional coding experience; ability to code from operative reports, progress, and other note types.

Must have an in-depth knowledge of Medicare and Medicaid documentation, coding, and billing regulations for applicable service lines(s) assigned, in addition to CMS Conditions of Participation. Additional knowledge of other third-party payer requirements for documentation, coding and billing preferred.

Ability to review clinical documentation to determine accurate ICD10, CPT, HCPCS and modifier assignment.

Ability to work remotely from home following Trinity remote work guidelines.

Expert knowledge in ICD-10 and CPT coding and medical terminology, with knowledge of Medicare, Medicaid, Health Maintenance Organization, and commercial insurance plans.

_Position Highlights and Benefits_

+ Comprehensive benefit packages available, including medical, dental, vision, paid time off, 403B, and education assistance.

+ We serve together in the spirit of the Gospel as a compassionate and transforming healing presence within our communities.

+ We live and breathe our guiding behaviors: we support each other in serving, we communicate openly, honestly, respectfully, and directly, we are fully present, we are all accountable, we trust and assume goodness in intentions.

Ministry/Facility Information:

+ Holy Cross Hospital in Fort Lauderdale, Florida is a full-service, non-profit Catholic hospital, sponsored by the sisters of Mercy and a member of Trinity Health.

+ We are committed to providing compassionate and holistic person-centered care.

+ We are the only Catholic hospital in Broward and Palm Beach counties and are not for profit. We are part of Trinity Health, one of the largest multi-institutional Catholic health care delivery systems in the nation. Together, we serve people and communities in 21 states from coast to coast, providing nearly 2.8 million visits annually.

+ Comprehensive benefits that start on your first day of work

+ Retirement savings program with employer matching

_Legal Info_

We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.

Our Commitment

Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.

Our Commitment to Diversity and Inclusion

Trinity Health is a family of 115,000 colleagues and nearly 26,000 physicians and clinicians across 25 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.

Our dedication to diversity includes a unified workforce (through training and education, recruitment, retention, and development), commitment and accountability, communication, community partnerships, and supplier diversity.

EOE including disability/veteran