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Work collaboratively with HIM Staff and Clinical Documentation Improvement Specialists(CDIS) to ensure the most accurate and complete documentation to support accurate coding/billing.
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Some roles include an overview of coding practices and clinical documentation, grievance and appeals processes, and outpatient services and equipment, within their scope. Become a part of our caring community and help us put health first.
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The Sr. CIS is expected to have deep knowledge of key aspects of the OSH business model, including (but not limited to): Risk score, Clinical documentation, and scribe performance as well as greenway and canopy utilization.
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Certified Coding Associate OR Certified Coding Specialist OR Certified Inpatient Coder ICD-10 OR Certified Outpatient Coding OR Certified Professional Coder. Assist in resolving billing edits that are holding patient claims from billing, by reviewing medical records and other applicable documentation.
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Experience with Smart on FHIR Apps and Da Vinci Prior Authorization Support, including the Coverage Requirements Discovery (CRD) and Documentation Templates and Rules (DTR) implementation guides, and Prior Authorization Support (PAS) is preferred.
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Knowledge of legal, regulatory, and policy compliance issues related to medical coding and documentation. Creates and provides group education and training based on accurate coding practices, coding compliance documentation, and regulatory provisions.
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The Medical Director may speak with contracted external physicians, physician groups, facilities, or community groups to support regional market priorities, which may include an understanding of Humana processes, as well as a focus on collaborative business relationships, value based care, population health, or disease or care management.
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Provides consulting and attending patient care services, including medically necessary visits with appropriate documentation, coding and billing capture, medical orders, prescriptions, family meetings, and coordination of care with facility staff and Care Guide Partners or community physicians.
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This position will also support detailed level reporting and analytics, clinical appeals, root cause analysis, and address identified trends in reasons for denials related to coding and/or OASIS related documentation.
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Experience with all phases of the Software Development Lifecycle, including system analysis, design, coding, testing, debugging and documentation. Web app frontend programming skills: Typescript, JavaScript, HTML, & CSS.
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Participates in admission, recertification, pre-authorization, and utilization review decisions when needed. Collaborates with facility administrator and director of nursing to ensure operational metrics aligned to achieve goals.
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Masters use of clinical systems to ensure efficient and excellent supportive documentation, appropriate and optimal coding levels, charge capture, and follow-through on all patient care orders.
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Review coding to ensure documentation is completed within Agency’s admission timeframe. Acts as a resource and has expert knowledge of Medicare, Medicaid, ICD-10 Coding and OASIS and other applicable regulatory requirements.
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The leader in medical scribes, patient navigation and back-office coding and billing coordination, HealthChannels trains and manages more than 22,000 employees across 50 states and three countries.
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