CODING QUALITY EDUCATION ANALYST - HIS CODING DEPT

CODING QUALITY EDUCATION ANALYST - HIS CODING DEPT 

2+ to 5 years experience

Minimum Education Requirements:

Associates Degree in Health Information Services or related field or 3 years coding experience.

Minimum Experience Requirements:

Required - 3 years coding experience in an acute care setting. 

Preferred: 2 years performing coding and documentation audits.

Minimum Licensure/Certification Requirements:

Must possess or be able to obtain RHIA, RHIT, CCS, or CPC within 12 months after hire.

Minimum Skill Requirements:

Proficient in software applications (Excel, word, 3M, SLH, Care Connect, Invision); Thorough knowledge of ICD9-CM and CPT. Expert in coding convention/automated encoder (knowledge management of NCCI/OCE billing edits); Knowledgeable in DRG methodologies and all regulatory/ payer requirements associated with coding. Demonstrates knowledge of and ability to apply THR coding policies and procedures to record review process. Demonstrates time management and organizational skills. Demonstrates clear and concise oral and written communication skills. Demonstrates strong decision making and problem solving skills; Personal initiative to keep abreast of new developments in coding

updates/technology/research/regulatory data; Successful completion of ICD 10-AHIMA Academy training: Certificate Holder 

JOB DUTIES / RESPONSIBILITIES:

- Assesses accuracy of MSDRG, APRDRG and APC assignment

- Confirms appropriate identification, coding and sequencing of pertinent secondary diagnoses and procedures severity of illness, etc. 

- Confirms coding of all diagnoses required to validate medical necessity.

- Validates the use or nonuse of the query tool. 

- Responsible for entry into database for tracking and trending

- Reviews audit with coder and coordinates with the CBO to re-bill of accounts as needed.

- Monitors for coder error trends in reviews and advises appropriate manger of identified trends/patterns.

- Identifies issues that relate to the clinical department and/or physician documentation and submits to denials management.

- Reviews records identified for HARMS; reconciles discrepencies with appropriate clinical department, Risk Management, Quality etc.

- Provide coding review summary reports to management as required.

- Accuracy of reviews 95% standard (As validated by Senior Analyst audits)

- Quantity of reviews performed meet established standards

- Provides feedback to employee on identified issues found during record review with supportive documentation as needed

- Responds timely to coder requests for assistance.

- Provides manager with quality and quantity performance data for use in performance reviews. Provides input into staff evaluations.

- Monitors for trends during review process and advises appropriate manager of identified trends/patterns reflecting need for individual action plan(s) or section education.

- Assists with the development of actions plans and implements with the oversight of the manager.

- Assists in the development and updating of procedures to maintain standards for correct coding.

- Participates in the coder interviews and administers coding skill test.

- Collaborates with the education coordinators in the training of new coding employees.

- Provides monthly summary to Senior Analyst of review activities and findings.

- Provides input in the development, refinement and implementation of methods and procedures used to complete review functions.

- Contributes to the development of educational/training opportunities for physicians and hospital clinical staff

- Participates in committee work and cross functional teams as needed by department management.

- Assists manager with the processes associated with the weekly DNFB to consistently meet entity/system targets; provides back up coverage for coding staff as needed.

- Analyzes and adjusts workload responsibilities based on changes in staffing/volumes etc.

- Monitors and resolves the Stockamp QUIC queues pertaining to DRG reviews according to schedule.

- Assists with requests to verify and review codes; charges on patient accounts and denials.

- Assists manager in monitoring and reporting coder productivity.

- Assists coding staff in resolving ITS issues impacting work efficiently; facilitates ticket submission, 

- Perform other duties as assigned

SKILLS AND CERTIFICATIONS

Associates Degree in Health Information Services or related field or 3 years coding experience 

Must possess or be able to obtain RHIA, RHIT, CCS, or CPC within 12 months after hire 

IDEAL CANDIDATE

Associates Degree in Health Information Services

3 years coding experience in an acute care setting

2 years performing coding and documentation audits

Thorough knowledge of ICD10