Computer Programmer - Cincinnati (Saint Louis, MO)

Computer Programmer - Cincinnati

Position Summary Audits the accuracy and completeness of diagnosis and procedure coding and APR-DRG assignment. General Purpose Problem resolution critical thinking auditing coding billing Essential Duties and Responsibilities Develops audit protocol for claim selection Performs review of selected claims by auditing the medical record post discharge to confirm accuracy and completeness of coding and DRG assignment Serve as a resource for APR-DRG coding rules and regulations Research communicate and educate others on coding changes that impact reimbursement Examine claims and calculate reimbursement based on contract terms to determine accuracy of payment through use of various reports and supporting documentation Build strong lasting relationships with clients payors and company personnel Attend client department and company meetings Comply with federal and state laws company policies and procedures Essential Skills and Experience Inpatient Coding certification from AHIMA such as RHIA RHIT or CCS. Familiarity with APR-DRG s particularly what diagnosis procedures impact APR-DRG assignment Extensive understanding of medical terminology anatomy and physiology and APR-DRG grouping methodologies Experience with or the willingness to learn commercial and government reimbursement methodologies Ability to apply general rules to specific problems to produce answers that make sense Ability to read and interpret an extensive variety of documents such as contracts claims medical records EOB s policies and procedure in written (English) and diagram form Ability to define problems collect data establish facts and draw valid conclusions Moderate computer proficiency including working knowledge of MS Office Mathematical skills ability to calculate rates using addition subtraction multiplication and division Strong customer service orientation Excellent interpersonal and communication skills Strong team player Commitment to company values High school diploma or equivalent