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Virtual Coding Account Resolution Specialist III in Nashville at Parallon

Date Posted: 11/21/2018

Job Snapshot

  • Employee Type:
    Full-Time
  • Location:
    Nashville
  • Job Type:
  • Experience:
    At least 3 year(s)
  • Date Posted:
    11/21/2018

Job Description

The Coding Account Resolution Specialist III (CARS-III) works inpatient coding related alerts/edits, predominately post initial/final coding. The CARS-III performs the alert/edit resolution activities in the applicable systems. The alerts/edits shall be worked according to the established procedures and thresholds, and communicated as appropriate. 

Duties (included but not limited to):
• Compiles daily work list from eRequest, CRT and/or other alert/edit systems
• Takes action and resolves alerts/edits daily following established procedures and thresholds
• Enters detailed notes to update eRequest to provide details if the alert/edit cannot be resolved or must be rerouted to another responsible party for research/resolution
• Escalates alert/edit resolution issues as appropriate to minimize final billing delays
• Monitors the aging of accounts held by an alert/edit, prioritizes aged accounts first, and reports to leadership
• Works with team members in billing, revenue integrity and/or the Medicare Service Center to resolve alerts/edits
• Assigns interim DRGs for in-house patients at month end
• Completes MOCK abstracts as necessary (e.g., combining the codes for outpatient and inpatient claims subject to the payment window)
• Assists the Coding Leads and/or Coding Managers in resolving unbilled reason codes (URC)
• Communicates coding revisions to the applicable party (e.g., CIS, lead, manager, international log)
• Periodically works with their Manager to review individual work accomplishments, discuss work problems/barriers, discuss progress in mastering tasks and work processes, and discusses individual training needs and career progression 
• Adheres to all applicable coding and billing regulations and guidance, including but not limited to, CMS, AHA and HCA policies and guidelines
• As needed, may periodically be asked to perform Coding Integrity Specialist III (CIS-III) duties
• Meets all educational requirements as stated in Company and HSC policy
• Reviews all official data quality standards, coding guidelines, Company policies and procedures and clinical/medical resources to assure coding knowledge and skills remain current
• Practice and adhere to the Company’s Code of Conduct philosophy
• Practice and adhere to the Company’s Mission and Values
• Other duties as assigned

Job Requirements

KNOWLEDGE, SKILLS & ABILITIES• Coding Technical Skills – ICD-10-CM, ICD-10-PCS, MS-DRGs, APR DRGs and associated reimbursement knowledge.
• Customer Orientation – establishes and maintains long-term customer relationships, building trust and respect by consistently meeting and exceeding expectations.
• Policies and Procedures – articulates knowledge and understanding of organizational policies, procedures and systems.
• Quality Orientation – accomplishing tasks by considering all areas involved, no matter how small; showing concern for all aspects of the job; accurately checking processes and tasks; being watchful over a period of time.
• Building and Maintaining Strategic Working Relationships – develops collaborate relationships to facilitate the accomplishment of work goals. Possesses good interpersonal skills in building, negotiating, and maintaining crucial relationships.
• Initiative – independently takes prompt proactive steps towards problem resolution. 
• Effective Decision Making – relating and comparing; securing relevant information and identifying key issues; committing to an action after developing courses of action that take into consideration resources, constraints, and organizational values. 
• Analytical Skills – effective evaluation, synthesis and use of information gathered. 
• Managing Conflict – dealing effectively with others in an antagonistic situation; using appropriate interpersonal styles and methods to reduce tension or conflict between two or more people. 
• Organization – establishing courses of action to ensure that work is completed efficiently; proactively prioritizes assignments and keen ability to multi-task. 
• Communication - communicates clearly, proactively and concisely with all key stakeholders. 
• Customer Orientation - establishes and maintains long-term customer relationships, building trust and respect by consistently meeting and exceeding expectations.
• Work Independently – is self-supporting; not needing to rely on others to complete a job.
• PC Skills - demonstrates proficiency in Microsoft Office applications and others as required. 

EDUCATION
• High School graduate or GED equivalent required. 
• Undergraduate (associate's or bachelor's) degree in HIM/HIT preferred. 

EXPERIENCE
• 1-year acute care inpatient coding experience required with 3 years’ experience preferred. 

CERTIFICATE/LICENSE 
• RHIA, RHIT and/or CCS preferred.