Carle Health · 8 hours ago
HIM Cert Coder/Quality Review Analyst OP 1k Sign on Bonus! REMOTE
United States
Full-time
Remote
Mid Level
$24.28/hr - $40.55/hrCarle Health is a healthcare system based in Urbana, IL, and they are seeking a HIM Cert Coder/Quality Review Analyst to ensure compliance with coding guidelines and standards. The role involves performing quality reviews of coding, providing feedback, and addressing coding-based denials while assisting with coder education and onboarding.
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
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)
Experience in coding
Benefits
Comprehensive benefits package
Company
Carle Health
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
10001+ employees
Funding
Current Stage
Late StageLeadership Team
Matthew Kolb
Executive Vice President, Chief Operating Officer
Dawn Walden
Senior Vice President, Chief Revenue Cycle Officer
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