Coordinates concurrent and retrospective payor claim audits and denials, medical records requests and review, and appeal activities for inpatient and outpatient services provided by Commonwealth Health Corporation's acute and sub-acute care facilities as well as CRSH, Medequip, Home Care Program, Blue Grass Outpatient Center, Cal Turner Extended Care Pavilion or other entities as identified and incorporates all payors audits and appeals. Conducts medical record reviews for medical necessity and DRG assignment, generates appeal letters, enters data in computer data base, generates monthly reports, and participates in interdisciplinary review processes and educational activities as needed. Also coordinates audits, records review, data entry and abstraction projects for Recovery Audit Contractors (RAC), Medicare Administrative Contractors (MAC), Quality Improvement Organizations (QIO), Fiscal Intermediaries (FI) and other special projects as identified.
Three (3) years' work experience in utilization review, clinical documentation improvement and payor appeals with demonstrated communication and leadership skills.
Education & Training:
Associates Degree in Health Information Technology and/or B.S. Degree in Health Records Administration and/or Certified Coding Specialist Certification and/or certification in a coding specific area and/or AHIMA Independent Study Course specific to coding.
R.H.I.T., R.H.I.A., C.C.S., C.C.A. ,CPC, or coding specific certification required. If not currently credentialed with one of the above certifications, must obtain within 12 months of hire date.