RHIT/RHIA Specialist

Daily Responsibilities:

Position Purpose: Review claims for the classification or coding of patients’ illnesses, diseases and medical problems to ensure accuracy of classification/coding which determine the payment amount. Identify claims or trends that require further investigation such as coding practices, diagnoses with potential for up coding, transfers of patients billed as discharges.

· Review claims and reports for the classification or coding of patients’ illnesses, diseases and medical problems to ensure accuracy of classification/coding and payment amount

Respond to provider inquiries regarding assignment of DRGs and appropriate payment

Generate standard and ad-hoc reports and analyze for management, Medical Management, Claims or Finance

Investigate pended claims to resolve problems related to the classification and coding of medical information and services and document, research and resolve in the phone log

Perform inter-rater utilization management audits

Verify accuracy of classification/coding data in the computer system

Maintain master patient database on inpatient reviews