Community Health Systems Professional Services Corporation is one of the leading operators of general acute care hospitals. The organization's affiliates own, operate or lease 131 hospitals in 29 states, with an aggregate of approximately 19,800 licensed beds. The consolidated organization owns and leases community hospitals that offer quality, cost-effective healthcare including a range of inpatient medical and surgical services, outpatient treatment and skilled nursing care. In over 60 percent of the markets served, CHS-affiliated hospitals are the sole provider of healthcare services.
Community Health Systems Professional Services Corporation seeks a Physician Document Review Specialist for its Franklin, TN, headquarters’ HIM team. The Physician Document Review Specialist performs documentation reviews, provides education in accordance with the Corporate Physician Compliance Review Plan for CHS affiliated providers, and assists in evaluation of new acquisitions and compliance projects at the direction of the CHS leadership team.
Essential Duties and Responsibilities
include the following. Other duties may be assigned.
Based an analysis of productivity, audits a random sampling of evaluation and management and procedural services to validate the accuracy of documentation within the medical record to ensure compliance with Medicare, Medicaid and other payer requirements.
Prepares a comprehensive report based on the findings of the documentation review.
Designs and presents provider specific education and training based on audit findings.
Works within the CHS compliance plan to notify CHS management of educational needs of providers and staff regarding coding and documentation.
Verifies the correct usage of the authorization of assignment form, waiver form, and consent forms for procedures.
Assists the organization’s compliance officers, as directed, to research and investigate complaints, concerns or questions relative to compliance issues.
Serves as a resource and liaison in the organization for all coding related topics, issues and questions.
Conducts educational training meetings and/or seminars in various CHS locations as well as the Corporate Physician Coding and Documentation Seminar.
Remains current on all changes in legislative regulations that impacts coding, documentation and compliance.
Assist in developing and maintaining educational materials needed to achieve compliance with regulations.
Ensures assigned projects are completed in a timely manner.
Maintains strict confidentiality of provider information, patient data as well as financial and billing data.
Reports noncompliance issues detected through auditing and monitoring to the department Senior Director.
Complies with all policies and procedures of the Corporate Compliance Program.
Attends meetings as requested. This may occasionally necessitate working in the evenings.
Performs related work as assigned.
Assists with special projects as assigned by their supervisor or the Senior Director of Physician Coding and Documentation.
Work with other staff members to inspire teamwork and promote cooperation.
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Fluent in the English language
Excellent oral, written and presentation skills required
Possess a vast knowledge of CPT, ICD 9 CM and HCPCS coding and reimbursement issues for physician offices and clinics
Strong knowledge of 1995 and 1997 Documentation guidelines
Excellent understanding and comprehension of medical terminology
Strong leadership, interpersonal and problem solving skills
Must have the ability to balance and juggle multiple tasks, projects and requests
Must be able to make sound decisions objectively and follow through
Ability to communicate effectively any issues or weaknesses with coding and documentation to the providers and/or CHS management in a one-on-one or classroom setting
Must be detail oriented and analytical
Able to interact confidently with providers, staff, corporate CHS management and/or other CHS affiliated personnel
Normal visual and auditory activity is required
Emotional and mental stability required to deal with periods of high stress
Possess clinical knowledge and ability to evaluate and summarize clinical records to support successful appeal
Ability to define problems, collect data, establish facts, and draw valid conclusions.
Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables.
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Must be able to sit for prolonged periods of time, work on keyboard and view monitor for majority of the work day. Extensive public speaking ability is required. Must be able to travel by both airplane and automobile, have the ability to carry luggage, computer cases and resources material long distances, whenever necessary. Must have the ability to lift carry-on luggage.
Certificates and Licenses:
CPC or CCS-P
- High School Diploma and/or GED
- Minimum of 5 years’ experience working in physician offices or clinics working with diagnostic and procedure coding and/or medical billing.
- Requires extensive knowledge of CPT, HCPCS, ICD 9 CM coding, medical terminology and the AMA’s 1995 and 1997 Documentation Guidelines
Health Information Management Services
TN-Franklin (Nashville Region)
Forecasted paid hours per shift
Forecasted hours per pay week
Community Health Systems - 19 months ago