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Sr. Coding Compliance Specialist - Work From Home

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Job ID 19REQ-00214 Location Hendersonville, Tennessee Other Locations Tallahassee, Florida Company Name Xtend Healthcare, LLC

Xtend Healthcare is located just 20 miles north of Nashville, Tennessee; Xtend provides entirely revenue cycle-based projects which range from complete business office outsourcing to A/R legacy cleanup, self-pay and third-party CBO safety net engagements as well as coding and consulting engagements.

We serve clients of all types and sizes in all 50 states -- from critical-access hospitals to those with more than 2,000 patient beds, and from individual facilities to multi-hospital, university-affiliated health systems.

In 2015, Xtend was acquired by Navient, is the nation's leading loan management, servicing and asset recovery company. By joining forces with Navient, the Xtend team will be bolstered by the strength, stability and resources of an industry leader, and leverage the parent company's large-scale business process outsourcing capabilities.

THIS POSITION IS A REMOTE POSITION.

Xtend Healthcare is looking for a Senior Coding Compliance Specialist who will be responsible for accurately auditing the coding (ICD-10-CM, ICD-10-PCS, CPT, HCPCS, Level I & II modifiers) of the following service types: facility inpatient, emergency room, outpatient surgery, observation, ancillary, recurring therapy, clinic, professional, and billing/coding edit resolution.  Will be working with multiple facility specific, state billing and coding guidelines as well as various Medicare Administrative Contractors nation-wide. 

JOB SUMMARY:

1.  Project Work.                                                                                                                    

            a. Auditing of Facility Coding (Inpatient).

2.  Record Keeping.                                                                                                               

            a. Completion of coder audit reports of accounts completed daily.

            b. Completion of Time Allocation reports daily.

            c. Completion of weekly audit reports for assigned staff.

3.  Analysis/Reporting.                                                                                                           

            a. Identifies trends and reports to Coding manager.

            b. Reports weekly statistics of audits completed.

            c. Develop and coordinate education training programs regarding trends identified.

MINIMUM REQUIREMENTS:

  • High School Diploma.
  • Eight plus years of experience with coding and/or billing in health care revenue cycle.  This should include hospital and physician practice.
  • An understanding of healthcare billing practices and compliant claims preparation for both governmental and commercial payers.
  • Electronic health record (EHR) expertise, including knowledge of a variety of vendors.
  • Specialty Coding Certifications:  The following are recognized professional certifications:  Ambulatory Surgical Center (CASCC), Anesthesia and Pain Management (CANPC), Cardiology (CCC), Cardiovascular and Thoracic Surgery (CCVTC), Chiropractic (CCPC), Dermatology (CPCD), Emergency Department (CEDC), Evaluation and Management (CEMC), Family Practice (CFPC), Gastroenterology (CGIC), General Surgery (CGSC), Hematology and Oncology (CHONC), Internal Medicine (CIMC), Interventional Radiology and Cardiovascular (CIRRC), Obstetrics Gynecology (COBGC), Orthopedic Surgery (COSC), Otolaryngology (CENTC), Pediatrics (CPEDC), Plastics and Reconstructive Surgery (CPRC), Rheumatology (CRHC), Surgical Foot & Ankle (CSFAC), and Urology (CUC).

PREFERRED QUALIFICATIONS:

  • Coding Certifications: The following are recognized professional certifications: Registered Health Information Technician (RHIT); Registered Health Information Administrator (RHIA); Certified Coding Associate (CCA); Certified Professional Coder (CPC); Certified Outpatient Coder (COC); Certified Inpatient Coder (CIC); Certified Coding Specialist (CCS); or Certified Coding Specialist – Physician (CCS-P); Certified Professional Medical Auditor (CPMA). Senior Coding Compliance Specialist team members are required to possess at least one of the above professional services coding certifications.
  • Continuing Education Requirements: Medical coders shall maintain the required continuing education hours in order to maintain current and proper national certification(s) requirements for this position.
  • Coding Test. Pass a pre-employment coding test that is provided, developed and administered by candidate management instructions, with a score of 80% or higher.
  • Must possess a working knowledge of Medicare and Local Medical Review Policy Guidelines.
  • Ability to function independently and as a team player in a fast-paced environment required.
  • Knowledge of inpatient and DRG coding.
  • Knowledge of computing observation hours.
  • Knowledge of coding infusions and injections. 
  • Knowledge of surgical coding.
  • Knowledge of Evaluation and Management coding.
  • Must be able to maintain the company accuracy rating of 95%. 
  • Must meet set weekly quota for productivity. 
  • Knowledge of the International Classification of Diseases, Clinical Modification (ICD-CM); Healthcare Common Procedure Coding System (HCPCS); and Current Procedural Terminology (CPT).
  • Knowledge of reimbursement systems, including Prospective Payment System (PPS); Ambulatory Payment Classifications (APCs); and Resource-Based Relative Value Scale (RBRVS).
  • Practical knowledge and understanding of industry nomenclature; medical and procedural terminology; anatomy and physiology; pharmacology; and disease processes.
  • Practical knowledge of medical specialties; medical diagnostic and therapeutic procedures; ancillary services (includes, but is not limited to, Laboratory, Occupational Therapy, Physical Therapy, and Radiology).
  • Make well-informed, effective, and timely decisions, even when data are limited, or solutions produce unpleasant consequences; perceives the impact and implications of decisions.
  • Utilize medical computer software programs to abstract, analyze, and/or evaluate clinical documentation and enter/edit diagnosis, procedure codes and modifiers.
  • Clearly express information (for example, ideas or facts) to individuals or groups effectively, taking into account the audience and nature of the information.
  • Display courtesy, empathy, and tact, developing and maintaining effective relationships with others; effectively work with individuals who are difficult, hostile, or distressed to resolve differences; and be able to relate well to people from varied backgrounds and in different situations.
  • Work with internal and external customers to assess their needs, provide information or assistance, resolve their problems, or satisfy their expectations.
  • Contribute to maintaining the integrity of the organization; display high standards of ethical conduct and understand the impact of violating these standards on an organization, self, and others.
  • Be open to and embrace change and new information; adapt behavior or work methods in response to new information, changing conditions, or unexpected obstacles; effectively deals with uncertainty. Cooperate by willingly accepting new assignments and forming relationships with customers/co-workers/supervisors.
  • A high level of effort and commitment towards performing the work, using efficient learning techniques to acquire and apply new knowledge and skills; uses training, feedback, or other opportunities for self-learning and development.
  • Understand and interpret written material, including technical material, rules, regulations, instructions, reports, charts, graphs, or tables; applies what is learned from written material to specific situations. Working Excel knowledge. 
  • Attention to detail and completeness with a thorough understanding of government rules and regulations, medical coding and reimbursement guidelines, and potential areas of risk for fraud.
  • Work planning is necessary in being able to understand assignments and establish priorities.  It is required that each coder be able to look at his/her work load and determine priorities for the day. 
  • Ability to respond to email or text correspondence in a timely manner.


All offers of employment are contingent on standard background checks. Navient and certain of its affiliated companies are federal, state and/or local government contractors. Should this position support a Federal Government contract, now or in the future, the successful candidate will be subject to a background check conducted by the U.S. Government to determine eligibility and suitability for federal contract employment for public trust or sensitive positions. Positions that support state and/or local contracts also may require additional background checks to determine eligibility and suitability.

EOE Race/Ethnicity/Sex/Disability/Protected Vet/Sexual Orientation/Gender Identity. Navient Corporation and its subsidiaries are not sponsored by or agencies of the United States of America.

Navient is a drug free workplace.

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