A Company That Strives to Improve Outcomes
Providing unique services that go above and beyond to protect and support our clients in the delivery of healthcare, is who we are. We stand apart from other medical liability insurance companies by providing services that leverage data analytics to reduce risks, and though leadership articles, blogs, white papers, and educational materials to improve patient outcomes. We don’t settle for business as usual, and we strive to be leaders in the evolving healthcare market. Our core product may be trusted insurance, but we package and deliver it with so much more. If you are ready to contribute to a company that is taking its industry by storm and making a difference in healthcare, Coverys is for you.
The Clinical Coder provides clinical interpretation and expertise for company-specific Risk Management Taxonomy and ICD codes. Clinical coders review claim files, abstract pertinent data, and translate descriptions of the malpractice event, medical diagnoses and procedures for the allocation of multiple code sets specific to the alleged malpractice event. The Clinical Coder facilitates improvement in the overall quality, completeness and accuracy of malpractice data through active participation in interrater reliability meetings, audits and ongoing evaluation of claim files.
Essential Duties & Responsibilities:
- Conduct the active review of open and closed professional liability claims across the Coverys enterprise, and input data of all factual profile information not already entered. This includes such components as allegation, clinical specialty named, case severity, location of injury or event, claimant demographics.
- Review and analyze records to identify all diagnoses, procedures and risks associated with the file.
- Clarify inconsistent or inaccurate data according to established procedures.
- Conduct assessment of work to ensure there is consistency in all coding areas within the claim file.
- Perform ongoing analysis of claims-related data; including preparation of initial reports of results (both didactic and graphic) that will position the data for higher level analysis
- Answers coding questions accurately and responsively.
- Serve as a clinical resource to the non-clinical staff in coding or interpretation of healthcare related information in the claim files.
- Assist with the education of non-clinical and newly hired staff with regard to ICD 10 and taxonomy coding.
- Perform periodic reviews of new, revised, or deleted code updates as well as Taxonomy Coding guidelines.
- Report regularly on daily activity, productivity, and findings of reviews
- Participate in department and company projects as determined by Clinical Coding Manager and Director of Data Governance.
- Recommend guideline changes and coding enhancements as appropriate.
Education, Requirements & Competencies:
- The ideal candidate is an RN with a combination of hospital based clinical background and experience that relates to medical record review, malpractice claim file review, or data coding in any other discipline.
- Registered Nurse degree is required, CPC designation preferred
- A minimum of eight years’ experience or a combination of experience and education is required.
- Demonstrates high standards for both accuracy and thoroughness; seeks ways to improve and promote quality; applies feedback to improve performance; monitors own work to ensure quality.
- Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists.
- Synthesizes complex or diverse information; performs a root-cause analysis of any and all adverse outcomes that result in a claim; collects and researches standards of care and their relationship to adverse scenarios; uses intuition and experience to complement data.
- Proficient in Microsoft suite of office programs (“MS Office”), particularly Microsoft Excel and Microsoft Word.
Coverys is an equal-opportunity employer. Coverys’ job openings are open to all without regard to race, color, national origin, gender, gender identity, religion, age, height, weight, disability, political beliefs, sexual orientation, marital status, family status, or veteran status.