Outpatient Denials Specialist (Outpatient Auditor)

Reviews and responds to Corporate Compliance Audits and serves as an ICD/CPT resource for the Heath System. Reviews denial trends and identifies coding issues and knowledge gaps.
  
Responsibilities include: 
   

1.  Provides APC assignment and coding support throughout the Health System.

·   Serves as a resource regarding ICD-10CM coding guidelines and APC information.

·   Provides APC assignment information and answers coding questions.

·       Performs monthly quality reviews on the outpatient coding staff.

2.  Reviews trends and identifies coding issues requiring In-service programs for Coding Analysts, physicians and other departments.

3.  Assists in monitoring all Peer Review Origination (PRO) activities that may impact the Centralized Coding Department.

·    Maintains close working relationship with Patient Accounts.

4.    Remains up-to-date on APC-APG system literature from all agencies.

• Knowledge, understanding of Federal APCs and NYS APGs.

• Maintains coding clinic up-dates.

5.    Performs related duties, as required.

EXPERIENCE AND QUALIFICATIONS

·    Bachelor’s Degree in Health Information Management or related field, preferred. 

·    Minimum of three (3) years coding experience, required.  Two (2) years experience in Chart Review/Hospital Reimbursement and regulatory background.

·    RHIA, RHIT or RN, CCS, CPC required.

·    Strong written, communication, presentation and organizational skills, required.