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
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