March 7, 2012

Consulting assignment with an immediate start, expected to last through the end of 2012 at the least   1.     Review clinical documentation and accurately identify CPT and Dx codes that should be used on the claim   2.     Research Medicare reimbursement policies   3.     Research industry standards reimbursement policies   4.     Be able to locate CCI and mutually exclusive bundling edits   5.      Proficient on coding guidelines on all the specialties   6.     Understanding Medicare’s reimbursement indicators   7.     In collaboration with other departments, review, translate and document CMS GEM (General Equivalency Mapping) crosswalk /mapping.   8.     Act as a liaison to coordinate between the different Workstreams and clinical groups that will be utilizing the mapping and be involved in the modeling work.   9.     Research industry wide initiatives that address industry ICD-10 challenges and propose solutions to the group   10.  Assist in the remediation/validation of ICD-10 diagnosis codes output from the mapping tool   Job specifications: Understanding ICD-9 codes and how they will translate to the new ICD-10 code set. Strong knowledge of the GEM mapping. Proficiency in assigning accurate medical codes for diagnoses, procedures and services performed in the outpatient setting Proficiency across a wide range of services, which include evaluation and management, anesthesia, surgical services, radiology, pathology and medicine

Knowledge of coding rules and regulations along with keeping current on issues regarding medical coding, compliance and reimbursement under outpatient services. A trained coding professional can better handle issues such as, claims denials, bundling issues, Medicare coding rules Vs AMA coding rules.

Working knowledge of AMA Coding guidelines, working knowledge in the assignment of ICD-9-CM codes Volumes 1 based on Coding.

Knowledge of clinical and medical terminology and technical concepts

Knowledge of clinical workflows.

 

Any of the following certifications are a must:

ICD-10 AAPC or AMA certification AND

CCS (AHIMA Certified Coding Specialist)

CPC (AAPC Certified Professional Coder)

Consulting

New York

NY