MRI a national consulting firm seeks a Certified Coder with a minimum of 3 years Department of Veterans Affairs experience to conduct audits (75% onsite-NJ/NYC area and 25% remote). Special focus in E&M, CPT, DRG, ER, Chemotherapy Infusions & Injections, High-Dollar Procedures and Fee-basis claims.
Review claims, in either soft or hard copy, electronic health records (EHR) to be reviewed include codes at all levels of complexity for both inpatient and outpatient claims
Review whether the E&M code level is supported by the documentation in the EHR for which the code is assigned.
Review whether the complexity of the visit meets the medical necessity criteria for the code level assigned.
Review whether modifiers are assigned correctly
Review whether all documented CPT procedures are captured and coded correctly.
Review whether the diagnoses (represented by the ICD-9-CM coding; or when applicable in the future ICD-10-CM (or later versions of coding guidance) support the medical necessity of the services provided.
Review whether DRG's are assigned correctly and if all Diagnoses and procedure codes are identified
Special focus Audits will include, but is not limited to:
Outpatient CPT Code focused audits (Chemotherapy; Dermatology, etc.);
Outpatient High Dollar Third Party claims (Top 5% dollar claims);
Outpatient Non-VA Emergency Room (ER) coding
Outpatient facility based coding audits;
Inpatient Non-VA Care admissions;
Inpatient focused audit on congestive heart failure (CHF) or pneumonia;
Inpatient professional fee audit;
Inpatient/outpatient surgical coding audits; and
High risk Prosthetic and DME services; additionally