HIM Cert Coder, Quality Review Analyst

🔥 0 minutes ago

🌽 Illinois – Remote

🌽 Illinois – Remote

💵 $24 - $40 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

🧐 Analyst

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Carle Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1946

⚕️ Healthcare Insurance

🏥 Healthcare

📚 Education

Healthcare Insurance • Healthcare • Education

Carle Health is a comprehensive healthcare provider dedicated to managing the health needs of its community. Offering a wide range of services, from general medical care to specialized treatments in oncology, cardiovascular, pediatrics, and women's health, Carle Health emphasizes quality patient care and community health initiatives. Additionally, it supports education and research through the Carle Illinois College of Medicine and engages in community health programs that aim to improve overall well-being.

📋 Description

• Perform accurate and timely quality reviews of internal and vendor coding team members using appropriate code sets and coding guidelines • Develop and deliver coding education based on quality review outcomes • Perform production coding when needed according to productivity and quality standards • Share quality review results with HIM leadership and recommend education and training • Determine the frequency and scope of coding quality reviews with HIM leadership • Compile and track quality review statistics and follow-up • Identify and report coder training, system, and documentation issues • Review and respond to coding denials and coding questions • Perform clinical validation of appeal letters and assist with editing them for documentation and regulatory compliance • Participate in system and new application testing • Review and resolve coding-based denials using EPIC WQs or other software • Provide denial trend data and analyze denied claims with management • Serve as subject matter expert for coding denials, providing guidance and education to coding staff, physicians, and hospital departments • Provide management reports on denial trends, appeal outcomes, and performance metrics • Identify work types for review based on coding scope and new coder onboarding needs • Develop and conduct group education on topics identified through quality and denial reviews • Assist HIM coding management in ensuring coding performed by HIM or vendors meets department standards • Participate in onboarding new coders, including intensive audits and reviews until fully trained

🎯 Requirements

• 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) • Work experience in coding • Ability to work Monday-Friday, 8 a.m.-5 p.m. with a flexible schedule

🏖️ Benefits

• $5,000 sign-on bonus • Comprehensive benefits package • Equal Opportunity Employer workplace protections