Remote Utilization Review Rn Jobs in Lexington, SC

Inspire health. Serve with compassion. Be the difference.

Job Summary

Essential Functions

• All team members are expected to be knowledgeable and compliant with Prisma Health's purpose: Inspire health. Serve with compassion. Be the difference.

• Codes medical information into the Prisma billing/abstracting systems using established professional and regulatory coding guidelines. Performs Inpatient coding including major traumas and Neonatal Intensive Care Unit (NICU) records by assigning International Classification of Diseases (ICD) and International Classification of Diseases-Procedure Coding System (ICD-PCS) codes as well as the Diagnosis Related Groups (DRG) assignment. Abstracts and assigns and verifies codes for Major Complications and Comorbidities/Complications and Comorbidities (MCC/CCs), Hospital-Acquired Condition/Patient Safety Indicator (HAC/PSI) and Quality Indicators capture as appropriate through documentation validation.

• Ensures that each diagnosis present on admission (POA) indicator is assigned appropriately. Codes for multiple facilities. Incumbent(s) operate under the general supervision of HIM Coding leadership.

• Applies ICD and ICD-PCS codes to inpatient records, including major traumas, and Neonatal Intensive Care Unit (NICU) records based on review of clinical documentation. Verifies assignment of DRGs, MCC/CCs, Hospital Acquired Conditions (HACs) and Patient Safety Indicators (PSIs) that most appropriately reflect documentation of the occurrence of events, severity of illness, and resources utilized during the inpatient encounter and in compliance with department policies and procedures. Selects the optimal principal diagnoses with appropriate POA indicator assignment and sequencing of risk adjustment diagnoses following established guidelines.

• Reviews work queues to identify charts that need to be coded and prioritizes as per department-specific guidelines and within designated timelines. Follows up on On-hold accounts daily for final coding.

• Identifies and requests physician queries following established guidelines when existing documentation is unclear or ambiguous following American Health Information Management (AHIMA) guidelines and established organization policies. Ensures all open queries initiated by Clinical Documentation Specialists have been addressed prior to final coding.

• Adheres to Prisma Health Coding and Compliance policies and procedures for assignment of complete, accurate, timely and consistent codes. Adheres to department standards for productivity and accuracy. Identifies and trends coding issues escalating identified concerns

• Consults, provides professional expertise to and collaborates with clinical documentation specialists on coding and documentation practices and standards.

• Performs other duties as assigned.

Supervisory/Management Responsibilities

• This is a non-management job that will report to a supervisor, manager, director or executive.

Minimum Requirements

• Education - Certification Program or Associate degree or Coding Certificate through American Health Information Management (AHIMA) or other approved coding certification program.

• Experience - Three (3) yearscoding experience in an acute care or ambulatory setting. Inpatient coding experience. EPIC health information system experiences preferred.

In Lieu Of

• In lieu of education and experience requirements noted above, successful completion of the IP Coder Associate program or coder associate may be considered.

Required Certifications, Registrations, Licenses

• Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), Certified Coding Specialist (CCS), Certified Inpatient Coder (CIC) or other approved coding credential.

Knowledge, Skills and Abilities

• Participates in on site, remote and/or external training workshops and training. Attends and participates in CDI-Coding Task Force and other collaborative training and education with CDI, PFS and Quality.

• Demonstrates proficiency in utilizing official coding books as well as the electronic medical record, computer assisted coding/encoding software, and clinical documentation information systems to facilitate coding assignment.

• Knowledge of electronic medical records and 3M or Encoder System.

• Knowledge of medical terminology and basic anatomy and physiology, pathophysiology, and pharmacology with the ability to apply this knowledge to the coding process.

• Knowledge of MS DRG prospective payment system and severity systems.

• Ability to concentrate for extended periods of time.

• Ability to work and make decisions independently.

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