Remote Utilization Review Rn Jobs in Kansas City, KS

BASIC FUNCTION:

Reviews patient records and assigns accurate codes for each diagnosis and procedure on the accounts assigned to coder. Applies knowledge of medical terminology, disease processes, and pharmacology. Demonstrates tested data quality and integrity skills. Performs chart verification as assigned. Performs final chart reviews as necessary.

SHIFT DAYS/HOURS:

Remote Position

Part-Time: 20-32 Hours per Week

Full-Time: 40 Hours per Week, Monday through Sunday.

PRN: As needed.

Hours and Days are Subject to change based on business necessity

EXPOSURE TO HAZARDS:

According to OSHA standards, this position is classified as low risk with little or no risk of exposure

EQUIPMENT USED:

Computer, Copier, Fax Machine, Phone and Printer

ESSENTIAL FUNCTIONS:

• Review and abstract patient medical records. Report diagnoses, treatments, as well as surgical and non-surgical procedures for CAH facility medical services.
• Perform coding duties of discharged patient medical records using AHA Coding Clinic for ICD-10-CM and ICD-10-PCS, AHA Coding Clinic for HCPCS, CMS ICD-10-CM Official Guidelines for Coding and Reporting, AMA CPT Assistant, and ACEP ED Facility Level Coding Guidelines.
• Correctly assigns ICD-10-CM/PCS and CPT/HCPCS codes creating APG group assignments.
• Abide by the standards of American Health Information Management Association (AHIMA) Standards of Ethical Coding. Concerns involving compliance issues are forwarded to the Manager of HIM for action.
• Abide by the standards of American Health Information Management Association (AHIMA) Code of Ethics. Concerns involving compliance issues are forwarded to the Manager of HIM for action.
• Apply accurate charges.
• Queries physicians when documentation in the record is inadequate, ambiguous, or unclear for coding purposes.
• Report unusual findings to the supervisor when coding.
• Ensure code assignment is supported by provider documentation.
• Maintain professional competency and knowledge of third- party payer and QIO regulations.
• Compliant with HIPPA, demonstrates discretion and integrity.
• Ability to work with minimal supervision.
• Other duties as assigned.

QUALIFICATIONS:

Education: A minimum of high school diploma plus successful obtainment and maintenance of the American Health Information Management Association (AHIMA) credentialCertified Coding Specialist (CCS) and/or CSS-P, Registered Health Information Technician (RHIT) or Registered Health Information Administrator (RHIA). Knowledge of and demonstrated appropriate use of ICD 10, ICD 10 PCS, and CPT coding. AAPC credential of CPC also acceptable.

Experience: Two years of coding and abstracting experience in ICD-9 CM/ ICD10-CM and PCS, DRGs and CPT including modifiers and APCs.

Certificates, License, Registrations: Certified Coding Specialist (CCS), CCS-P, Registered Health Information Technician (RHIT) or Registered Health Information Administrator (RHIA)

Knowledge, Skills and Abilities: Thorough knowledge of the related Prospective payment systems (PPSs) and CAH payment methodology; Broad knowledge of pharmacology indications for drug usage and related adverse reactions; Knowledge of ancillary testing (laboratory, X-ray, EKG); Knowledge of anatomy, physiology and medical terminology; Understanding of coding practices and guidelines; Experience with PC, 3M encoding systems; Auditing skills for coding quality and compliance; Strong process management skills; Good communications skills in working with the public as well as co-workers; Basic Knowledge of MS Excel. Maintain compliance with HIPAA and patient confidentiality.

Physical: Light Work: Exerting up to 20 pounds occasionally, and/or 10 pounds of force frequently, or negligible constantly. Walking or standing to a significant degree or sitting constantly and pushing/pulling controls.

INTERPERSONAL RELATIONSHIPS:

Supervision Received: HIM Manager

Supervision Exercised: None

Other: Hospital personnel, medical staff, other medical facility personnel, some public/patients