Coding Analyst & Educator, Coding Education

Coding Analyst & Educator, Coding Education

40 hours per week, day shift

JOB SUMMARY: Performs account review and provide education to coding staff on documentation accuracy, quality standards, and best coding practices to ensure compliance with WFBMC compliance standards, Medicare, OIG, AMA, and health insurance payor policies. Functions as an organizational coding expert for ICD 9 CM, CPT, and ICD 10- CM and PCS, and additionally supports the Director/Assistant Director Coding Quality Review and Education in training and re-training of coders as directed. Performs reviews, analyze results and problem-solve issues identified in account reviews and special projects that are conducted as part of frequent and close collaboration with various departments in the organization including Providers, Professional Coding, and Revenue Integrity staff. Completes standard account reviews, root cause analysis for incorrectly coded accounts, evaluate work queues for reporting, and insure that the method in which the organization meets licensure requirements is maintained. Maintains complete and appropriate documentation on all review findings for statistical and compliance purposes, and for financial and billing improvement purposes. Additional responsibilities include providing feedback to the clinical staff on documentation issues and reviewing coding denials with the Patient Financial Services staff. Takes the lead, under the direction of the Director/Assistant Director, to develop and manage risk-based reviews for outpatient and/or inpatient coding and related denials. As directed, recommends, initiates, manages and/or conducts specific facility billing and compliance audits to evaluate completeness of medical record documentation in support of codes assigned for services provided. Special duties and projects may additionally be assigned to this incumbent in support of the department goals.

EDUCATION/EXPERIENCE: Five years coding quality audit experience including inpatient or outpatient, day surgery and emergency, in an acute care facility. Experience in an academic medical center preferred. EPIC health information system experience preferred.

LICENSURE, CERTIFICATION, and/or REGISTRATION: Coding certification CCS, CCS-P (as well as other recognized coder certifications) or RHIT/RHIA.

ESSENTIAL FUNCTIONS:

1. Performs coding quality review as directed for inpatient and outpatient accounts, including OP, Ambulatory Surgery, and Emergency patient types, and including validation of appropriate ICD-9 CM/ICD-10 diagnoses, E&M codes, PCS/CPT procedure codes, and DRGs and APCs as appropriate in EPIC/3M and coding-related applications and the Electronic Medical Record. Determines whether coding entries are accurate, complete, and are supported by documentation

2. Reviews facility charges as relevant and edits where necessary to ensure charges are optimal, compliant and substantiated by provider/clinical documentation.

3. Participates in training other coders as directed. Acts as a mentor when assigned.

4. Serves as a coding resource for managers, other coders, and departments external to HIM and Coding.

5. Responds to inquiries from Patient Accounts or other departments as requested.

6. Communicates with Manager when trending request volumes impact productivity.

7. Participates in accurate data collection, evaluation and recommendations of coding process improvements.

8. Demonstrates full understanding and is compliant with correct coding initiative guidelines, regulatory requirements regarding coding of medical information including but not limited to external regulatory agencies such as Quality Improvement Organizations (QIOs), the Centers for Medicare & Medicaid Services (CMS) and other payers, and the Joint Commission.

9. Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association (AHIMA) and adheres to official coding guidelines.

10. Queries physician when existing documentation is unclear or ambiguous following AHIMA guidelines and established policy as part of the auditing process.

11. Brings identified concerns to supervisor for resolution.

12. Produces specific reports on a monthly basis per established parameters.

13. Stays abreast of current developments, advancements, and trends in applicable areas and the program requirements of accreditation agencies and federal, state, and private health plans by attending seminars/workshops, reading professional journals, and actively participating in professional organizations. Integrates knowledge gained into current work practices.

14. Participates in on site and/or external training workshops as opportunities arise to improve quality of reviews and the organizations coding processes.

15. Maintains credentials, and submits written evidence of maintenance.

16. Participates as a member of the Clinical Documentation Management Program. Mentors and assists in the training and professional growth of other team members. Consults with the Clinical Documentation Specialists and Coding Compliance Coordinators as needed. Consults with and educates/trains providers and other staff on coding practices and conventions. Attends and participates in continuing education including in-service programs, coding seminars and workshops to maintain current understanding of coding developments, changes, and regulations. Assists Managers as requested.

SKILLS/QUALIFICATIONS:

• Effective oral and written communication skills
• Strong customer service skills
• Excellent problem-solving and critical thinking skills
• Ability to concentrate for extended periods
• Demonstrates proficiency in utilizing official coding books as well as the electronic medical record, computer assisted coding/encoding software (3M/360 system preferred), and clinical documentation information systems to facilitate code assignment.
• Demonstrates ability to work and contribute as part of an interactive problem solving team
• Ability to work effectively, independently, and manage multiple demands consistently
• Above average skill in ICD 9/ICD-10 CM and PCS and CPT coding classification systems, diagnosis and procedure selection, and sequencing guidelines
• Strong knowledge of MS DRG prospective payment system and severity systems
• Demonstrates competence in coding and correct extrapolation of official coding and select billing guidelines to specific coding situations
• Ability to apply broad guidelines to specific coding situations, independently utilizing discretion and a significant level of analytic ability

WORK ENVIRONMENT:

• Moderate noise environment
• Clean, well-lit, comfortable climate

PHYSICAL REQUIREMENTS:

0% 35% 65% to to to 35% 65% 100% N/A Activity

X Standing

X Walking

X Sitting

X Bending

X Reaching with arms

X Finger and hand dexterity

X Talking

X Hearing

X Seeing

Lifting, carrying, pushing and or pulling:

X 20 lbs. maximum

X 50 lbs. maximum

X 100 lbs. maximum