Senior Clinical Coding Analyst

2 weeks ago

Cebu City, Central Visayas, Philippines Health Business Solutions LLC Full time

Senior Clinical Coding Analyst

Health Business Solutions, LLC Metro Cebu (On-site)

We are seeking an experienced and detail-oriented Senior Clinical Coding Analyst to join our team and take on a crucial role in ensuring coding quality within our revenue cycle. As a Senior Clinical Coding Analyst, you will be responsible for analyzing and validating clinical codes used in the revenue cycle processes, identifying areas of improvement, and implementing coding quality initiatives. Your expertise in clinical coding, regulatory guidelines, and revenue cycle operations will play a vital role in maintaining accurate and compliant coding practices.

Company Overview:

For over 20 years, we've been a leading middle market revenue cycle management (RCM) vendor, providing comprehensive financial and operational solutions to health systems, physician groups, or specialty medical practices. Our mission is to improve the overall financial health of our clients by offering customized, data-driven, and tech-enabled recovery of denied claims and aged receivables. We utilize our deep expertise in revenue cycle to help transform our client's revenue cycle processes to achieve sustained reductions in denial rates.

Key Responsibilities:

  1. Analyze and evaluate clinical codes used in the revenue cycle, including diagnosis codes (ICD-10-CM), procedure codes (CPT/HCPCS), and related modifiers.

  2. Conduct regular audits of coded medical records, ensuring accuracy, completeness, and compliance with relevant coding guidelines, industry standards, and regulations.

  3. Identify coding discrepancies, documentation deficiencies, and areas for improvement in the coding and revenue cycle processes.

  4. Collaborate with coding teams, healthcare providers, and revenue cycle stakeholders to resolve coding-related issues, clarify documentation requirements, and ensure accurate code assignment.

  5. Develop and implement coding quality initiatives, including education and training programs, to enhance coding accuracy, compliance, and productivity.

  6. Stay up-to-date with the latest changes in coding guidelines, regulations, and industry best practices, and ensure timely implementation of necessary updates within the organization.

  7. Provide guidance and mentorship to coding staff, assisting in the resolution of complex coding cases, and promoting professional development.

  8. Generate regular reports and metrics related to coding quality, productivity, and compliance, highlighting areas of concern and recommending actionable improvements.

  9. Collaborate with IT teams and other stakeholders to optimize coding tools, software, and systems, ensuring seamless integration within the revenue cycle processes.

  10. Participate in coding-related projects, committees, and cross-functional teams, representing the coding and revenue cycle perspective and contributing to organizational goals.

Qualifications:

  1. Bachelor's degree in Health Information Management, Health Informatics, or a related field. Relevant certifications (e.g., RHIA, RHIT, CCS) are highly desirable.

  2. Extensive experience in clinical coding within a healthcare organization, with a strong focus on revenue cycle processes.

  3. In-depth knowledge of coding guidelines, such as ICD-10-CM, CPT/HCPCS, and relevant modifiers, as well as understanding of CMS, HIPAA, and other regulatory requirements.

  4. Proficient in using coding software, encoders, and electronic health record (EHR) systems.

  5. Excellent understanding of revenue cycle workflows, including charge capture, billing, claims processing, and reimbursement methodologies.

  6. Proven track record in conducting coding audits, implementing coding quality improvement initiatives, and achieving measurable outcomes.

  7. Exceptional attention to detail and accuracy, coupled with excellent organizational and problem-solving skills.

  8. Effective communication and interpersonal skills, with the ability to collaborate with diverse stakeholders, provide education, and resolve coding-related issues.

  9. Ability to work independently, prioritize tasks, and meet deadlines in a dynamic and fast-paced environment.

  10. Proficiency in using coding-related software and tools, as well as a high level of computer literacy.

Join our dynamic organization as a Senior Clinical Coding Analyst, and contribute to the enhancement of coding quality within the revenue cycle, ensuring accurate and compliant coding practices that support optimal healthcare outcomes.

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