Utilization Review Case Manager Jobs in Mobile, AL

USA Health is Transforming Medicine along the Gulf Coast to care for the unique needs of our community. USA Health is changing how medical care, education, and research impact the health of people who live in Mobile and the surrounding area. Our team of doctors, advanced care providers, nurses, therapists, and researchers provides the region's most advanced medicine at multiple facilities, campuses, clinics, and classrooms. We offer patients convenient access to innovative treatments and advancements that improve the health and overall well-being of our community.

• The DRG / APC Coordinator's department responsibilities:
  • Requires minimal supervision to safely perform all responsibilities.
  • Maintains a clean and secure workstation.
  • Utilizes and accesses the Hospital Information System (Cerner), 3M / Solventum, Vincari and any other applicable computer applications as assigned.
  • Analyzes Medicare / DRG Payer inpatient records and assigns the correct ICD-10-CM diagnosis and ICD-10-PCS procedure codes, for optimal reimbursement. Analyzes Medicare / APC / EAPG Payer outpatient and emergency room records and assigns the correct ICD-10-CM diagnosis, ICD-10-PCS procedure codes and the correct CPT or HCPCS procedure codes, for optimal reimbursement.
  • Assures the diagnoses and procedures coded have been documented in the medical record by the physician.
  • Develops and assigns provider Coding Queries when documentation clarification is needed in order to assign the most accuratce and appropriate code.
  • Properly identifies the principal diagnosis, secondary diagnoses and any procedure codes as required by CMS.
  • Reviews all coding denials and audits, determines proper course of action and end effectively communicates and / or completes the action(s) necessary for resolution.
  • Communicates with Hospital Business Office to answer questions concerning coding and billing issues and performs any follow-up as needed.
  • Keeps the Coding Manager informed of problems and / or concerns.
  • Refers all coding software problems to Coding manager promptly for resolution.
  • Stays informed about coding changes and updates through the review of the Federal Register, CMS websites, publications such as the Coding Clinic and CPT Assistant, etc.
  • Must be able to accurately code a minimum of 2 to 3 Medicare / DRG Payer inpatient records per hour and a minimum of 5 outpatient surgery / outpatient in a bed / outpatient / observation records per hour or 12 emergency room records per hour.
  • Works with the medical staff, CDI, social services, nursing, ancillary care staff, discharge planning, utilization review and care managers concerning documentation requirements and the correct assignment of all coding, including severity of illness and risk of mortality.
  • Actively reviews and works all coding queues as assigned by the Coding Manager to ensure the oldest accounts are coded first such that all records are coded within five days of discharge.
  • Attends and / or assists the Coding Manager with coding meetings related to HACs, PSIs, PDIs, etc.
  • Performs related duties as assigned.
• The (DRG/APC Coordinator) documentation responsibilities:
  • Maintains accurate and complete records.
  • Accurately assigns coding "holds" when documentation needed for coding is missing.
  • Maintains accurate logbooks / spreadsheets.
  • Updates Cerner / Solventum (3M) information as needed.
• The (DRG/APC Coordinator) citizenship responsibilities:
  • Accepts and completes all duties positively and without conflict.
  • Cooperates, helps others and improves the performance of the coding department.
  • Completes all mandatory unit, educational and hospital requirements.
  • Utilizes cost effective practices in performing all aspects of the job.
  • Adheres to current Infection Control and Safety Standards.
• OTHER DUTIES AND RESPONSIBILITIES:
  • Other duties as assigned / required.
  • Participates on committees and / or ad-hoc groups as assigned.
  • Participates in Performance Improvement activities as assigned.
• The (DRG/APC Coordinator) professional responsibilities:
  • Abides by and enforces all compliance requirements and policies and performs these responsibilities in an ethical manner consistent with the organization's mission, vision and values.
  • Adheres to hospital policies including confidentiality.
  • Requires regular and prompt attendance.
  • Works the assigned schedule including overtime as required.
  • Assists with orientation of new employees and training of other coders as assigned.
• The DRG / APC Coordinator's Communication Responsibilities:
  • Communicates and uses appropriate customer relation skills with physicians, patients, families and healthcare team in person and via telephone.*Excellent written communication skills.
  • Responds timely to emails and phone calls.
  • Informs / relays information to Coding Manager regarding any unfinished requests and / or duties.
• Completes all mandatory department, educational and hospital requirements
• Adheres to current Infection Control and Safety Standards
• Regular and prompt attendance
• Ability to work schedule as defined and overtime as required
• Related duties as assigned

Employees must be in a regular position, working 20 hours or more per week (.50 FTE or greater) to qualify for benefits.

• Associate's Degree in Health Information Technology or practical nursing and 5 years experience coding inpatient/ outpatient Medicar/DRG Payer records in an acute care hospital setting Required OR
• Bachelor's Degree in Health Information Management or Nursing and current licensure with the state of Alabama as a registered nurse will substitute for 2 years of the required experience Preferred
• RHIT - Registered Health Information Technician with AHIMA Upon Hire Required and
• CCS-Certified Coding Specialist from the AHIMA Upon Hire Required or
• Certification as a Certified Professional Coder - Hospital from the American Academy of Professional Coders Required
• Current licensure with the state of Alabama as an LPN Required
• Registry with the AHIMA as a Registered Health Information Administrator is highly Preferred
• Comparable combination of education and experience may substitute for the above requirements.

Knowledge, Skills, and Abilities

• Excellent computer, communication and customer service skills are required HighExcellent computer, communication and customer service skills are required High
• Excellent verbal and written communications skills. HighExcellent verbal and written communications skills. High
• Excellent organizational skills and attention to detail. HighExcellent organizational skills and attention to detail. High
• Excellent time management skills with a proven ability to meet deadlines. HighExcellent time management skills with a proven ability to meet deadlines. High
• Strong analytical and problem-solving skills. HighStrong analytical and problem-solving skills. High
• Must be organized and demonstrate the ability to follow policies and directives. HighMust be organized and demonstrate the ability to follow policies and directives. High
• Ability to multi-task in an efficient, thorough, and prioritized manner to work quickly, accurately and independently. HighAbility to multi-task in an efficient, thorough, and prioritized manner to work quickly, accurately and independently. High
• Willingness to learn new skills and continuously improve knowledge, skills and abilities. HighWillingness to learn new skills and continuously improve knowledge, skills and abilities. High
• Ability to act with integrity, professionalism, and confidentiality. HighAbility to act with integrity, professionalism, and confidentiality. High
• Ability to maintain confidentiality of information, most importantly patient financial and health record information in accordance with federal and state laws and regulations HighAbility to maintain confidentiality of information, most importantly patient financial and health record information in accordance with federal and state laws and regulations High
• Ability to solve practical problems and deal with a variety of variables HighAbility to solve practical problems and deal with a variety of variables High
• Excellent communication skills required. HighExcellent communication skills required. High
• Must be organized and demonstrate the ability to follow guidelines. HighMust be organized and demonstrate the ability to follow guidelines. High
• Demonstrated ability to work independently and collaboratively on teams is required. HighDemonstrated ability to work independently and collaboratively on teams is required. High
• Knowledge of ICD-10 and CPT coding systems HighKnowledge of ICD-10 and CPT coding systems High