PURPOSE OF THIS POSITION
The primary purpose of the HIS Coding Integrity Auditor & Educator is to support the integrity of the coding integrity program which is a key driver of accurate reimbursement, quality scores, benchmark data and statistical reporting. The primary scope of responsibility includes claims derived from the HIS Co team; however, may provide support in an advisory capacity to other divisions within BVHS, as appropriate. Implements educational opportunities in relation to current and upcoming coding guidelines and practices. Collaborates with HIS Professional Coding Integrity Auditor and Educator as well as leadership to ensure consistency within the HIS coding program, as applicable.
- Duty 1: Participate along with coding leadership to develop and maintain coding-related policies and procedures to promote compliant and consistent coding practices, inclusive of ICD/DRG, ROM/SOI/APR-DRG, CPT/APC code assignments which are reflective and supported by clinical documentation. Collaborate with professional coding leadership to ensure consistency between facility and professional coding policies and procedures, as applicable. Monitors and implements educational guidance in anticipation of changing organizational needs (e.g. implement a new service line) and/or in response to revised regulatory requirements (e.g. IPPS and OPPS annual updates, CPT Assistant, Coding Clinic, etc.). Ensure appropriate dissemination of information and education to ensure coding team and/or any other pertinent individuals or departments remain current on coding policies and procedures.
- Duty 2: Regularly performs or coordinates the completion of coding quality reviews for accounts submitted by the HIS facility coding team. Document results, analyze data, identify issues and report findings to leadership of impacted areas. Will provide education in a peer-to-peer environment on audit findings and areas of opportunity to the Coding Integrity associate(s). The Coding Integrity Auditor & Educator will help facilitate ongoing follow-up auditing and education as a result of action plans.
- Duty 3: Assist to identify clinical documentation opportunities that may impact the DRG, APR or APC assignment, including query appropriateness or opportunity. Provide feedback to Clinical Documentation Integrity (CDIS) Specialist or clinical area, as appropriate.
- Duty 4: Partners with Revenue Integrity, Patient Financial Services (PFS), and other areas, as appropriate, to conduct internal audits, as needed, of claims to ensure the accuracy and completeness of code capture (reconcile “hard” and “soft” coding); which is supported by clinical documentation.
- Duty 5: Reviews and responds to third party payer audits related to code assignments. Resolves identified issues; documents relevant decisions related to coding practice in policies or procedures to promote ongoing standardization and consistency. Provides feedback to the Coding Integrity team of identified coding opportunities through third party payer audits.
- Duty 6: Provide support and guidance to Corporate Compliance Department in audits or initiatives related to coding. This may include participating in coding audits in response to an investigation or potential compliance risk, conducting coding research, offering advisory guidance to other BVHS entities, or interacting with third party consultants conducting a compliance review.
- Duty 7: Lends support to other departments, such as Quality, PMO, Case Management, or other organizational initiatives or projects where the coded data is a key driver in outcomes, benchmarking, or evaluation of the data being reported or utilized. Serves as a member on committees, task force or projects as the coding representative, as necessary.
- Duty 8: Develops and provides education to HIS coding team , other departments/associates, as necessary and medical staff (in collaboration with the CDI Specialists, Professional Coding Auditor and Educator, as appropriate) regarding general coding education, regulatory updates, etc. Tracks attendance and demonstrates competency of the participants of the course content.
- Duty 9: Participates in regular and active coding of various work types and works coding related edits as time permits, to support the HIS as needed.
- Duty 10: Performs second-level and coding consult reviews prior to final coding when prompted by HIS Coding Integrity Specialists, and acts as an organizational resource for coding-related questions. Utilize internal and external credible resources to investigate complex coding issues (e.g. conflicting coding guidelines, differing interpretation of guidelines, etc.) to provide guidance or recommendations to leadership to establish compliant coding practices.
- College degree in a related field including, but not limited to health information management, a clinical profession, or 5+ years of experience from which comparable knowledge and abilities have been acquired.
- Certified Coding Specialist (CCS) required
- 5+ years facility hospital inpatient and outpatient coding experience (ICD and CPT) required
- Proficient knowledge of facility reimbursement methodologies required
- General understanding of revenue cycle and reimbursement methodologies
- Proficient knowledge of regulatory requirements and compliance required; proficiency in researching coding issues (e.g. Coding Clinic, CPT Assistant, CMS website, etc.) required.
- Ability to provide education individually or to a group in a clear, concise and effective manner
- Must possess positive service-oriented and interpersonal skills; strong communication, including written and verbal presentation skills, required.
- Ability to compile, analyze and effectively present data and complex information in an informative and meaningful way to a variety of audiences, including leadership.
- Ability to manage multiple tasks/projects. Excellent organizational, time management and prioritization skills required. Self-directed.
- Proven competence in utilization of computer applications, including Microsoft Office applications (Excel, Word, PowerPoint) and health-care related applications, including an Encoder, required.
- RHIA, RHIT certification
- Professional coding experience
- Facility and/or professional billing knowledge
- Previous auditing experience
- Experience providing education in a peer-to-peer environment
This position requires a full range of body motion with intermittent activities in sitting, walking, lifting, bending, squatting, climbing, kneeling, twisting and standing. The associate must be able to lift 50 pounds or more and reach work above the shoulders. The individual must have excellent eye/hand coordination with the ability to grasp, push and pull, fine finger dexterity and manipulation. This position requires corrected vision and hearing in the normal range. The associate must have excellent verbal skills to communicate with patients, physicians, and co-workers.
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