Surgical Review Specialist, Full-time(Remote)

Company: St. Luke's University Health Network
Location: Allentown
Posted on: October 27, 2024

Job Description:

St. Luke's is proud of the skills, experience and compassion of its employees. The employees of St. Luke's are our most valuable asset! Individually and together, our employees are dedicated to satisfying the mission of our organization which is an unwavering commitment to excellence as we care for the sick and injured; educate physicians, nurses and other health care providers; and improve access to care in the communities we serve, regardless of a patient's ability to pay for health care.
The Surgical Review Specialist prospectively reviews, validates, and audits procedure code assignment in accordance with AHA ICD-10-CM and AMA CPT-4 coding conventions, UHDDS guidelines and CMS directives. Researchs failed claims, identifies discrepancies and communicates resolution to appropriate departments.
JOB DUTIES AND RESPONSIBILITIES:

• Prospectively reviews, validates, and audits OR procedure code assignment for HIM, OR and/or general surgery cases according to AMA CPT-4 coding conventions utilizing EPIC and/or other OR applications as appropriate
• Identifies potential patient class mismatches based on planned OR Surgical CPT-4 assignment for all scheduled OR cases
• Ensures that appropriate IP patient class is obtained for IP only Medicare cases prior to date of service
• Ensure all IP only procedures for Medicare cases have an Inpatient order prior to discharge as well as communicate all IP only procedures for commercial insurance
• Conducts reviews of cases lost with feedback to respective departments
• Conduct concurrent review with utilization review department for post op surgical cases with potential status issues, procedure changes or entry of incorrect patient class orders to ensure accurate patient status prior to discharge
• Audit CPT -4 codes provided by coders to ensure accuracy and correct patient class obtained prior to discharge, communicate back to PEC for re-authorization, as needed
• Is a resource to the Coding department, SLPG practices, providers, Pre-Encounter Center, Utilization Review Department and Billing department
• Assists with outstanding HIM Waiting for Information queues researching outstanding inpatient and/or outpatient accounts for resolution. Research may include, but is not limited to, missing documentation, outstanding OR dictations, incorrect and/or missing charges, incorrect CPT code assignment, incorrect registrations and/or physician queries
• Serves as liaison between Physician Advisor/Medical Director, Finance, Utilization Review Department and CDCI.
  PHYSICAL AND SENSORY DEMANDS: -
  Sitting for up to 7 hours per day, 3 hours at a time. Repetitive arm/finger use retrieving/viewing computerized patient medical record and abstracting of patient information. Extended periods of vision use for reviewing computerized patient records, abstracting of patient information, approximately 7 hours per day, 3 hours at a time. Hearing as it relates to normal conversation. Occasionally may be required to use upper extremities to lift up to 10 lbs.; stoop, bend, or reach to retrieve resource materials and/or paper records in accordance with department downtime policy.
  EDUCATION:
  RHIA, RHIT, CCS and/or CPC strongly preferred. Will consider RHIA, RHIT, CCS and/or CPC -eligible or candidate currently enrolled in health information technology/management program or other health-related field. If candidate is not RHIA, RHIT, CCS or CPC and/or possess no credentials, then candidate will be expected to obtain their AHIMA/AAPC credential within three years of hire date to retain position.
  TRAINING AND EXPERIENCE:
  Minimum 1-3 years demonstrated outpatient coding experience in acute care, teaching setting; knowledge of inpatient coding preferred. Working knowledge of CPT-4 required; ICD-10-CM preferred. Knowledge of anatomy and physiology, pathophysiology, and medical terminology required. Previous experience with EPIC patient medical record system and 3M encoding system preferred.Please complete your application using your full legal name and -current home address. -Be sure to -include -employment history for -the past seven (7) years, including your present employer. - Additionally, you are -encouraged to upload a current resume, including all work history, education, and/or certifications and -licenses, if applicable. -It is highly recommended that you create a profile at the conclusion of submitting your first application. -Thank you for your interest in St. Luke's!!

Keywords: St. Luke's University Health Network, East Brunswick , Surgical Review Specialist, Full-time(Remote), Healthcare , Allentown, New Jersey