Senior Coding Compliance Specialist

About Xtend Healthcare
Xtend Healthcare is a revenue cycle management company focused exclusively on the healthcare industry. The company's services range from full revenue cycle outsourcing, A/R legacy cleanup and extended business office to coding and consulting engagements. As part of Navient (Nasdaq: NAVI), Xtend taps the strength and scale of a large-scale business processing solutions company. Learn more at www.xtendhealthcare.net

Xtend Healthcare is looking for a Senior Coding Compliance Specialist. This position will be responsible for accurately auditing the Inpatient 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.The auditing will be on outside contacts.

JOB SUMMARY:

1. Project Work:

• Auditing of Facility and/or Professional Inpatient Coding

2. Record Keeping:

• Coding Audit Reports

• Time Allocation Report

• Summary Documentations                                                         

3. Analysis/Reporting    

• Identifies trends from clinical documentation

• Reports weekly statistics of audits completed

• Develop and coordinate education training programs   

LOCATION: Remote/Work from Home. (All work must be performed in the United States for this remote role.)

OFFICE AND TECHNOLOGY REQUIREMENTS:

Xtend Healthcare will provide all hardware and software.  Qualified candidates must secure the following to successfully execute job responsibilities:

• ​Reliable high-speed internet– 100mbps download, 10 upload speed minimum, and latency less than 25 ms.(Please note: Rural, Satellite Services, MIFI/Jetpacks, 5G networks, Google Pod, EERO Device and WIFI extenders are not compatible with our systems)

• Cell phone that has the ability to download an app

• Wired internet connection by connecting an Ethernet cord into your server from the router/modem

• Computer equipment will be provided on Day 1 of Training

• Private workspace or home office free from distractions

• As a work-from-home employee, I understand that I may encounter slowdowns during periods of heavy internet use due to a variety of factors; one of which is the number of devices connected to the internet in the home and especially devices streaming Netflix, Hulu, games etc. I understand that WiFi is not compatible with company systems and that connecting device directly to the router will provide the best connection.

MINIMUM REQUIREMENTS:

• High school diploma

• Five plus years of experience with Inpatient Coding in health care revenue cycle.This should include hospital and physician practice

• Knowledge of inpatient and DRG coding.

• 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). Coding Auditing Specialist team members are required to possess at least one of the above professional services coding certifications.

• Coding Test. Pass a pre-employment Inpatient Coding test that is provided, developed and administered by candidate management instructions.

PREFERRED QUALIFICATIONS:

• An understanding of healthcare coding and billing practices and compliant claims preparation for both governmental and commercial payers for facility and professional services.

• Revenue Cycle Certifications:  The following are recognized professional certifications:  Certified Revenue Cycle Representative (CRCR) or Certified Professional Medical Auditor (CPMA).

• 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).

• 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.

• 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 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.