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Carle Health · 1 day ago

HIM Cert Coder/Quality Review Analyst OP

Champaign, IL

Full-time

Onsite

Mid Level

$24.28/hr - $40.55/hr

Carle Health is a healthcare system based in Urbana, IL, and they are seeking a HIM Cert Coder/Quality Review Analyst OP. The role is responsible for quality reviews of coding by internal and vendor teams, ensuring compliance with coding guidelines and standards, and providing feedback and education to coders.

Hospital & Health Care

Responsibilities

Perform accurate and timely quality reviews of internal and vendor coding team members using appropriate code sets and coding guidelines

Develop and perform timely coding education to internal and vendor coding team members on coding systems, coding standards, protocols and Carle coding workflow as required based on quality review outcomes

Perform as a production coder when needed in a manner aligned with current coding productivity and quality standards

Shares results of quality reviews to HIM Leadership with recommendations for education and training

Works with HIM leadership to determine frequency and scope of coding quality reviews for specific coders and vendors

Compile and track statistics related to the review function, completed quality reviews, and follow up from those reviews

Identifies coder training needs, system issues, and/or documentation issues and reports them timely to HIM leadership

Review and respond to coding denials and coding questions as requested or assigned and performs clinical validation of appeal letters as needed

Assists in editing appeal letters ensuring clinical documentation support and regulatory guidelines are considered

Participates in system and new application testing as needed

Review and resolve coding-based denials using EPIC WQs or other software

Provide denial trending data to leadership as requested

Works with Manager to analyze denied claims and identify trends for education

Serves as subject matter expert (SME) for coding denials providing guidance and education to coding staff, physicians and other hospital departments

Provides regular reports to management on denial trends, appeal outcomes and overall performance metrics

Identifies work types to be reviewed based on the coding scope and new coder onboarding needs of the HIM department

Develops and performs HIM coding team member group education on coding topics identified during quality reviews and denial reviews

Assist the HIM coding management in assuring all coding performed by HIM or HIM vendors meets department standards

Qualification

Certified Professional Coder (CPC)Certified Coding Specialist (CCS)Registered Health Information Administrator (RHIA)Coding experienceQuality review skillsCommunication skillsTeam collaboration

Required

Certified Professional Coder (CPC) - American Academy of Professional Coders (AAPC)

Certified Coding Associate (CCA) - American Health Information Management Association (AHIMA)

Certified Coding Specialist (CCS) - American Health Information Management Association (AHIMA)

Registered Health Information Administrator (RHIA) - American Health Information Management Association (AHIMA)

Registered Health Information Technician (RHIT) - American Health Information Management Association (AHIMA)

Certified Professional Coder - Payer (CPC-P) - American Academy of Professional Coders (AAPC)

Certified Professional Coder - Hospital (CPCH) - American Academy of Professional Coders (AAPC)

Highschool diploma or G.E.D

Coding experience

Benefits

Carle Health offers a comprehensive benefits package for team members and providers.

Company

Carle Health

Glassdoor3.6

Carle Health is a vertically integrated system with a bold but simple mission: to be the trusted partner in all healthcare decisions for everyone who depends on it.

Founded in 1946