Careers With Purpose

Sanford Health is one of the largest and fastest-growing not-for-profit health systems in the United States. We're proud to offer many development and advancement opportunities to our nearly 50,000 members of the Sanford Family who are dedicated to the work of health and healing across our broad footprint.

Facility: GSS National Campus
Location: Sioux Falls, SD
Address: 4800 W 57th St, Sioux Falls, SD 57108, USA
Shift: 8 Hours - Day Shifts
Job Schedule: Full time
Weekly Hours: 40.00
Salary Range: $20.50 - $33.00

Job Summary

Based on location and depending upon role, the Coding Verifier may perform the following tasks, but not limited to, working collaboratively with Plan departments and will be responsible for review and interpretation of current medical policies for systematization. Must be able to translate written policy interpretation, have experience translating Legislate Mandates, and maintain policies and mandates each time updates are released into current procedural terminology (CPT), healthcare common procedure coding system (HCPCS), and international classification of diseases (ICD-10) codes for input into systems. Monitor compliance with policies and procedures relevant to clinical data reviewed. Perform updates/revisions to the criteria file of CPT-4 and HCPCS codes. Perform auditing functions for quality review, review all codes for accuracy and database to criteria file before implementation of policy. Must handle internal and external areas requests to investigate current state and historical of changes made to a particular CPT-4/HCPCS/Diagnosis code such as effective dates, messages used, parameter limitations. Review of scripts concerning Edits in criteria file. Review logic concerning implementation of policies. Assist the Quality Assurance Specialist and other departments on criteria loading to best accommodate implementation of benefits. Ensure files (provider/criteria) are loaded correctly in order to receive proper Edits from Experian and assists in the development of customized policy and payer communication.

In some locations depending upon role, the Coding verifier may perform the following tasks but not limited to reviewing medical documentation from physicians and other healthcare providers. Serve as a resource for providers in understanding payable indications and supporting documentation. Review diagnostic and procedure codes, symptoms, diseases, injuries, surgeries, and treatments according to official classification systems and standards. Provide accurate and timely review of ICD coding of diagnoses, ICD and CPT procedure code review, and diagnosis related group (DRGs) or ambulatory payment classifications (APCs) in accordance with official coding standards, regulatory coding compliance guidelines, and company procedures. Support both technical and professional services. Maintain a thorough understanding of National Correct Coding Initiative (NCCI) edits as appropriate for the role. Understands and support the Medicare workflows related to denial review and appeals management, including the preparation of documents and information.

Qualifications

Associate's degree in Health Information Technology, Certified Coding Specialist, or business related field required; Bachelor's degree preferred.

Professional and procedural coding experience preferred.

OR

Oncology experience preferred. Experience in utilization and knowledge of Current Procedural Terminology (CPT) and International Classification of Diseases (ICD) strongly recommended.

Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Outpatient Coder (COC), Certified Professional Coder (CPC) and/or Certified Coding Specialist (CCS) preferred or must obtain within 18 months of hire. Depending on department of hire, certification may be required.

OR

Currently holds an unencumbered Licensed Practical Nurse (LPN) or Registered Nurse (RN) license with State Nursing board and /or possess multi-state licensure.

Benefits

Sanford Health offers an attractive benefits package for qualifying full-time and part-time employees. Depending on eligibility, a variety of benefits include health insurance, dental insurance, vision insurance, life insurance, a 401(k) retirement plan, work/life balance benefits, and a generous time off package to maintain a healthy home-work balance. For more information about Total Rewards, visit https://sanfordcareers.com/benefits .

Sanford is an EEO/AA Employer M/F/Disability/Vet. If you are an individual with a disability and would like to request an accommodation for help with your online application, please call 1-877-673-0854 or send an email to talent@sanfordhealth.org .

Sanford Health has a Drug Free Workplace Policy. An accepted offer will require a drug screen and pre-employment background screening as a condition of employment.

Req Number: R-0200635
Job Function: Revenue Cycle
Featured: No