Outpatient - E&M - Medical Coding - FTH

Regulatory, Risk & Forensic

Our Regulatory, Risk & Forensic team supports client leaders to translate multifaceted risk and an evolving regulatory environment into defensible actions that help strengthen, protect, and transform organizations. Join our team and use advanced data, AI and emerging technologies with industry insights to help client service teams bring clarity from complexity and accelerate their path to value creation.

Position Summary

Level: Consultant

As an experienced Consultant at Deloitte Consulting Services, you will be responsible for individually delivering high quality work products within due timelines. Need-basis you will be mentoring and/or directing junior team members/liaising with onsite/offshore teams to understand the functional requirements.

Work youll do:

As a Regulatory, Risk & Forensic Operate professional, you will have the opportunity to work on multiple projects leveraging your education and prior work experience to help our clients more confidently make decisions to drive performance.  You will help our clients embrace change, grow their business, accelerate performance, and navigate periods of crisis or controversy and emerge resilient.

Role Overview:

Conduct coding and billing compliance reviews on medical records with primary focus on Evaluation and Management (E/M) level of Service validation and Missing Procedures (CPT/HCPCS) review to ensure complete and accurate charge capture prior to billing. The review of the medical documentation is conducted to identify additional missed provider documentation clarifications and/or missed coding opportunities. When discrepancies are identified, updates code as needed and provide detailed rationale and supporting evidence for all recommendations.  The professional will utilize the following resources to perform the reviews (not inclusive): The Official Coding Guidelines, ICD-10-CM/PCS, CPT and HCPCs coding guidelines, Federal and State regulations, the American Hospital Association (AHA) coding guidelines including the Coding Clinic and American Medical Associations  (AMA) CPT Assistant publications and American Health Information Association (AHIMA) compliant query guidelines. 

Outpatient coding reviews

•        Performs coding and billing quality reviews on hospital outpatient records to validate the medical record documentation supports appropriate Evaluation and Management (E/M) level selection and CPT/HCPCS reporting (including modifiers, as applicable) prior to billing submission. Responsibilities include, but are not limited to:
  • o   Outpatient E/M Level of Service Review (99211-99215): Review the encounter documentation (e.g., assessment and plan) and validate that the assigned E/M level is accurate and supported; revise the E/M level when not supported and provide clear, written rationale for the change.
  • o   Missing Procedure Code Review for various specialties: Review documented services and procedures to confirm complete charge capture; identify missing and/or incorrect CPT/HCPCS codes (and modifiers, as applicable), update coding accordingly, and document supporting rationale. Specialties include (not exhaustive): Dermatology, Ophthalmology, Orthopedics Medicine, Otolaryngology, etc.
  • o   Identifies missed documentation clarification opportunities and provides appropriate clinical parameters to support compliant documentation queries.
  • o   Evaluates the appropriateness and compliance of coder-generated clinical documentation queries.
  • o   Coordinates with downstream stakeholders to ensure corrected coding is routed appropriately and moved forward for billing.

Professional coding reviews

•        Performs coding quality reviews on professional encounters to validate that the medical record documentation supports accurate E/M level selection and complete/accurate CPT/HCPCS reporting (including modifiers, as applicable) prior to billing submission. Responsibilities include, but are not limited to:
  • o   Outpatient E/M level of Service Review (9921199215): Validate that the assigned E/M level is supported by documentation; revise the E/M level when necessary and provide written, detailed rationale and supporting evidence.
  • o   Missing Procedure Code Review for various specialties: Validate that all documented procedures/services are appropriately captured; identify missing CPT/HCPCS codes (and modifiers, as applicable), correct coding as needed, and document rationale. Specialties include (not exhaustive): Dermatology, Ophthalmology, Orthopedics Medicine, Otolaryngology, etc.
  • o   Identifies missed documentation clarification opportunities and provides appropriate clinical parameters to support compliant documentation queries.
  • o   Evaluates the appropriateness and compliance of coder-generated clinical documentation queries.
  • o   Escalates repeatable coding/documentation themes and supports education/feedback based on review outcomes.
  • o   Coordinates with downstream stakeholders to ensure corrected coding is routed appropriately and moved forward for billing.

Qualifications

Required Candidate Profile:

•        3-5 years of experience in audit of complex outpatient, hospital outpatient and professional coding and US healthcare claims
•        Must hold a coding certification from American Health Information Association (AHIMA) and/or from American Academy of Professional Coders (AAPC) such as a CCS, COC, CPC, CIC etc.
•        A graduate from field of medicine or allied healthcare subject is preferred
•        Must have experience working on EMR system Epic
•        Good understanding of US healthcare 
•        Demonstrate ability to interact effectively with clients including providers and internal stakeholders
•        Must be a dependable and reliable player, able to work independently and as part of a goal-oriented team with a positive attitude
•        Must have strong analytical, reasoning and organizational skills
•        Experience designing, implementing, and operating risk management and compliance activities
•        Prior consulting experience is preferred
• Should have worked on coding and billing domains (i.e. hospital outpatient, emergency department (ED), ambulatory surgery, professional coding, Outpatient etc.)
• In-Depth knowledge of various billing rules OPPS, MPFS etc.
• Thorough knowledge of payment rules hierarchy, fee schedule configuration and their impact on payment
• Superior skills to effectively communicate and negotiate across the business and external health care environment
• Hands-on experience in any of the Encoder tools specific to Hospital coding such as Epic, 3M etc.

Location:

Shift Timings:

       11 AM to 8 PM or as per business requirements