Pathways Hospice
Introduction:
Located in Fort Collins since 1978, Pathways provides care for those navigating the last months of life and support programs for their families. Pathways provides compassionate, excellent, comprehensive community care for those who have an advanced medical condition, serious illness and those who are grieving in Larimer and Weld Counties, including Fort Collins, Loveland, Greeley and Windsor.
Job Description:
POSITION SUMMARY:
Under the direction of the Director of Quality, Compliance & Education or the Director of Corporate Compliance, the HIM Analyst will perform audits of medical records and billing activities; providing auditing support to the clinical staff, ensuring documentation meets regulatory standards. Auditing functions include utilizing auditing tools as identified or developed by the Director, in line with training programs and processes. This position ensures that the training and auditing are in compliance with professional standards, regulatory requirements, billing guidelines and standards of practice. Additionally, the HIM Analyst will use coding skills to assist providers with billing optimization.
Scope: Home care, hospice, palliative care and provider billing.
KEY REPORTING RELATIONSHIPS:
Reports to Director of Corporate Compliance & Risk Management/Director of Quality, Compliance & Education
ESSENTIAL DUTIES:
- Work to maintain audit processes and audit tools related to documentation entered in the electronic medical record.
- Perform billing and documentation audits in accordance with established processes. Provide recommendations for documentation improvement to Director of Clinical Services and/or Clinical Manager.
- Identify patterns or trends in audit results and recommend remediation, including additional training or corrective action.
- Assist Director of Quality, Compliance & Education/Director of Corporate Compliance & Risk Management to incorporate compliance and audit findings into training programs.
- Assists in response to audits requested by external agencies, including assistance with development of appeals.
- Utilize certification in coding to assist providers with billing optimization.
- Follows coding guidelines and legal requirements to ensure compliance with federal and state regulations.
- Provide feedback to providers regarding documentation and associated billing codes to ensure billing optimization.
- Other duties and responsibilities as assigned.
CORE COMPETENCIES:
- Supports the mission and values of hospice and palliative care.
- Experience in utilizing CPT and ICD coding systems.
- Intermediate level knowledge of Excel, Word and Power Point
- Experience in medical record auditing, utilizing electronic medical records.
- Must be able to identify technical deficiencies in documentation and coding.
- Familiarity with medical terminology.
- Able to both work independently and as part of a team.
- Strong critical thinking and analytical skills. Knowledge of hospice and home health regulations and statutory language and interpretation.
- Ability to multitask, prioritize and manage time efficiently.
- Strong organizational skills.
- Excellent written and verbal communication skills and the ability to positively influence others.
- Able to perform other related duties as required or assigned, including education and training with staff or providers.
PHYSICAL REQUIREMENTS:
Ability to lift/carry a minimum of 30 lbs.
Prolonged, extensive or considerable standing/walking/sitting
Occasional reaching/lifting/carrying
Manual dexterity and mobility
Visual and auditory acuity
WORKING CONDITIONS:
May be exposed to infections and contagious diseases
Exposure to variety of electro-mechanical hazards
Subject to varying and unpredictable situations
Able to maintain job performance in emergency or crisis situation
Required Qualifications:
POSITION QUALIFICATIONS:
Minimum Experience: Two years’ experience working with electronic medical records; two years’ experience auditing medical records; two years’ experience working with quality and compliance in health care setting preferred.
Required Certificate: Medical Coding Certificate: ICD 10 coder required.
Education Qualifications:
Minimum Education: High School degree; Associate’s degree preferred