This position manages and monitors all coding activities performed for Gunnison Valley Hospital, oversees the nurse auditors and auditing activities, serves as the Privacy Officer, and performs insurance defense, state, and federal audits for Gunnison Valley Hospital

Education: Bachelor’s Degree

Experience: Two years inpatient, outpatient, and/or professional fee coding. Knowledgeable in ICD-10 CM/PCS and CPT coding conventions and encoder software. Minimum one year of clinical experience, preferably in a hospital setting. Familiarity with health care relevant legislation and standards for the protection of health information and patient privacy. Experience performing insurance defense audits and appeals is highly desirable.

Licenses/Certification: AHIMA CCS; RN; CDIP or CDIS preferred

Essential Functions:

• Manages and oversee all outsource coding company activities to ensure compliance with the Standards of Ethical Coding as set forth by the American Health Information Management Association (AHIMA) and in compliance with ICD-10 Official Coding Guidelines and other regulatory requirements, including CMS and OIG.
• Works closely with outsource coding company to ensure timely and efficient coding and to effectively manage the DNFB report, deficiencies and other metrics per GVH standards
• Develops and maintains a HIPAA compliant privacy program and ensure adherence to privacy standards by serving as the HIPAA Privacy Officer
• Performs insurance defense, federal and state audits in conjunction with Patient Financial Services whenever required by reviewing all medical documentation, coding, and billing, and appealing recoupment whenever feasible.
• Works collaboratively to coordinate Health Information Management functions with clinical departments within the hospital.
• Serves as the subject matter expert in coding and billing in conjunction with Patient Financial Services, including researching new or changing requirements related to documentation, coding and billing practices.
• Develops and maintains updated coding, documentation, and auditing policies and procedures, and works with and cross-references with all relevant departments.
• Develops training resources in conjunction with outsource coding company for providers regarding coding changes, and to ensure documentation supports coding for risk gaps, social determinants of health and performance and/or quality measures as necessary.
• Develops and maintains audit processes to ensure complete documentation, coding accuracy and appropriate reimbursement.
• Works with coding staff to ensure accurate coding for reimbursement and clinical care and to answer all questions regarding outstanding accounts
• Works with physicians and other providers to improve the quality of clinical documentation

• Coordinates with Records Release staff members to ensure security of protected health information

  (Please note: further specific duties of HIPAA Privacy Officer may be found in separate document).
• Manages and oversees nurse auditor activities, and ensure that charge capture responsibilities are being moved to the respective departments to reduce the manual charge entry done by nurse auditors.

Compensation: $36.38 - $47.69/hr, depending on experience.

Benefits Eligibility

Medical, dental, vision, health care FSA, dependent care FSA, and Lifestyle Spending Account: All active employees working 40 or more hours per pay period in a Full Time or Part Time position are eligible for benefits on the first of the month after hire.

Full Time staff are automatically enrolled in 401A plan as of date of hire.

Life and AD&D insurance: All active employees working 40 or more hours per pay period are eligible for benefits on the first of the month after hire date.

Short-term and long-term disability: All active employees working 60 or more hours per pay period are eligible for benefits on the first of the month after hire date.

Education

• Bachelors or better

Licenses & Certifications

• RN