Clinical Outcomes Analyst, Sr. jobs in Medford, OR

As a Clinical Coding Analyst, you will play an important role, including the following responsibilities:

• Reviewing pre-bill inpatient chart specific to MS DRG assignment.
• Identifying revenue opportunities and compliance risks based on the Official ICD-10-CM/PCS Guidelines for Coding and Reporting, AHA Coding Clinics, disease process, procedure recognition, and clinical knowledge.
• Preparing and composing all recommendations, including increased reimbursement, decreased reimbursement, and “FYI” for each account and communicating that to the client.

You will be the ideal candidate for this role if you have:

• AHIMA coding credential of CCS, RHIT, RHIA, CDIP or ACDIS credential of CCDS.
• Minimum of 7 years of acute inpatient hospital coding, auditing, or CDI experience in a large tertiary trauma/teaching hospital.
• Knowledge of ICD-10 CM/PCS.
• Experience with electronic health records (i.e., Cerner, Meditech, Epic, etc.).
• Excellent oral and written communication skills.
• Analytical ability, initiative, and resourcefulness.
• Ability to work independently.
• Excellent planning and organizational skills.

• Clinical Coding Analysts are assigned to a specific client(s) and has the primary responsibility of daily pre-bill chart reviews and communication to the client(s) within a 24-hour time frame for each chart reviewed.
• Provides daily client volumes to Manager no later than 7am EST.
• Reviews the electronic health record to identify both revenue opportunities and potential coding compliance issues-based ICD-10-CM/PCS coding rules, AHA Coding Clinics, and clinical knowledge.
• Provides verbal review on all cases with a potential MS DRG recommendation and/or physician query opportunities with Physician(s) via telephone call prior to submitting recommendations to the client.
• Ensures that the daily work list is uploaded into the MS DRG Database for assigned client(s) and enter required data elements for each patient recommendation into MS DRG Database.
• Prepares and composes all recommendations, including increased reimbursement, decreased reimbursement, and “FYI” for each account and communicates that to the client within 24 hours of receiving and reviewing the electronic medical record.
• Follows internal protocol on all client questions and rebuttals on cases reviewed within 24 hours of receipt.
• Responsible for review and appeal, if warranted, on Medicare and/or third-party denials on charts processed through the MS DRG Assurance program.
• Responsible for reviewing inclusions and exclusions specific to 30 Day Readmissions and Mortality quality measures on specific cohorts for traditional Medicare payers for specific clients.