Inpatient & Outpatient - Medical Coding

Healthcare Consultant – Inpatient Coding

Business Overview

Deloitte provides you an opportunity to gain valuable hands-on experience working alongside leading professionals across diverse industries while building your professional skills in a variety of project experiences. Our Deloitte practice helps organizations effectively navigate business risks and opportunities—from strategic, reputation, and financial risks to operational, cyber, and regulatory risks—to gain competitive advantage. We apply our experience in ongoing business operations and corporate lifecycle events to help clients become stronger and more resilient. Our market-leading team’s help clients embrace complexity to accelerate performance, disrupt through innovation, and lead in their industries.

Work you’ll do

As a professional in our Regulatory Healthcare Practice, 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.

Projects may be aligned to the following areas and include:

• Operational Improvement: For business process that include significant regulatory requirements, you will improve efficiency and business outcomes by leverage process improvement and operating model evolution.
• Clinical Payments Optimization: Assisting clients by validating that payments for clinical healthcare services comply with regulatory and contractual requirements while also determining that payments are appropriate for the type and level of care provided.
• Regulatory Response: Supporting clients with their most pressing regulatory and operational challenges. Helping them to identify, remediate, monitor, and manage enterprise risks and create value through implementing a compliant, resilient enterprise. Includes helping clients manage and respond to internal and external investigations, regulatory concerns and other business controversy.

Role Overview:

Conducts coding and billing compliance reviews on medical records to validate the ICD-10-CM and ICD-10-PCS codes, CPT and HCPCS codes for various specialty (including but not limited to Inpatient, outpatient, professional and Medicare advantage setting). The review of the medical documentation is conducted to identify additional missed provider documentation clarifications and/or missed coding opportunities. 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 Association’s (AMA) CPT Assistant publications and American Health Information Association (AHIMA) compliant query guidelines.

Responsibilities:

General

• • Maintains current with the Center for Medicare and Medicaid Services (CMS) coding, documentation guidelines, AHA Coding Clinics and other industry specific resources and clinical documentation query protocols
• • Identifies documentation improvement opportunities that impact coding accuracy

Inpatient (IP) coding reviews

• Performs coding and billing quality reviews on inpatient records to validate the medical record documentation supports the MS-DRG/APR-DRG assignment by validating the appropriate ICD-10-CM/PCS code assignment for:
  • Principal diagnosis assignment
  • Secondary diagnoses
  • Procedures
  • Present on admission (POA) indicators
  • Accurate discharge status assignment
• Identifies missed documentation query opportunities to further clarify documentation. Provides appropriate clinical parameters in recommendation to support the missed query opportunity
• Identifies missed coding opportunities that would impact the MS-DRG/ APR-DRG assignment or impact quality metrics (i.e., Severity of Illness (SOI) / Risk of Mortality (ROM))
• Validate the payments as per the specialty specific billing rules

Required Candidate profile

• Excellent organizational skills with ability to trend and track audit findings effectively.
• Must have experience working on multiple EMR systems including Cerner, Allscripts, MDAudit, Meditech, etc.
• Hands-on experience in any of the Encoder tools specific to Hospital coding such as 3M, Trucode, etc.

Qualifications

• • Experience designing, implementing, and operating risk management and compliance activities
  • Experience participating in risk, quality and compliance transformational programs preferred
  • Experience leveraging data and analytics to enhance risk management, quality, and compliance
  • Prior consulting experience is preferred

Knowledge, Skills & Abilities:

• Requires exceptional critical thinking, communication skills and a strong clinical knowledge base
• Must possess effective interpersonal skills in order to interact effectively with client
• Must possess knowledge of a wide range of specialized coding disciplines, including a strong knowledge base in anatomy and physiology, pathophysiology, and pharmacology; and knowledge of the CMS Official Coding Guidelines, AHA Coding Clinic and AHIMA Query Practice Brief guidelines.
• Requires basic computer word processing skills (e.g., formatting, editing, printing, composing email, internet searches, etc.) to be able to successfully navigate through an electronic medical record using a computer
• Effectively disseminate client/coding updates to the team in an individualistic and understandable manner
• Effectively identify and escalate areas of concern or training needs independently
• Requires the ability to read, write and speak effectively in English
• Proficiency in verbal and written communication skills essential to interacting with clients and teams including presentation skills (MS Power Point, MS Visio)
• Advanced proficiency with tools like Excel