Job Description

Job Description

Certification Details

• BLS

Job Details

• Performs internal quality assessment reviews on OUH coders to ensure compliance with national coding guidelines and OUH coding policies for complete, accurate and consistent coding.
• Coordinates and directs day-to-day coding educational activities.
• Facilitates and provides coding educational classes/presentations to staff as required.
• Communicates outcomes to improve accuracy, integrity, and quality of patient data and physician documentation.
• Assists Coding Leadership in root cause analysis of coding quality issues, performing account reviews, and preparing training documents.
• Leads, coordinates and performs all functions of quality reviews for inpatient and outpatient coding across OUMS.
• Provides Coding Integrity Specialist (CIS) and CQR education as needed.
• Initiates rebilling process as required per policy on special projects.
• Researches coding opportunities and escalates as needed.
• Assists in review, improvement of processes, education, troubleshooting and recommends prioritization of issues.
• Monitors QA results to assist Coding Leadership in root cause analysis and educational opportunities.
• Assists with curriculum development and ensures coding staff adherence with coding guidelines and policy.
• Demonstrates and applies expert level knowledge of medical coding practices and concepts.
• Participates on special reviews or projects.
• Maintains or exceeds 95% productivity and accuracy standards.
• Reviews all official data quality standards, coding guidelines, company policies and procedures, and clinical/medical resources to assure coding knowledge and skills remain current.
• Performs annual education needs assessment for strategic coding education program.
• Communicates coding topics and question trends to Coding Leadership for global education.
• Coaches and mentors coding staff as they develop and grow their coding skills.
• Provides skilled coding support through scheduled coding meetings and as needed.
• Researches external sources for common coding trends and questions.
• Applies adult learning concepts when developing or delivering educational programs.
• Provides high level of customer service.
• Practices adherence to Company’s Code of Conduct, ethics philosophy, Mission and Values.
• Audits outpatient coding accounts including Same Day Surgery, Observation, complex and simple Clinic visits, treatment series, and ED visits.
• Participates in training and mentoring of new outpatient coders and provides education to the outpatient coding team.

Job Requirements

• Extensive regulatory coding knowledge including ICD-10-CM, ICD-10-PCS, CPT-4, Modifiers, MS-DRGs, POA assignment, APR-DRGs and APCs where applicable.
• Effective decision making skills relating and comparing information, identifying key issues, and committing to action considering resources and organizational values.
• Adaptability to major changes in work responsibilities or environment.
• Initiative to independently take prompt proactive steps toward problem resolution.
• Ability to contribute to team success by actively participating as a team member.
• High work standards and accountability for completing assignments or tasks.
• Clear and concise verbal and written communication skills.
• Customer orientation to establish and maintain long-term customer relationships.
• Interpersonal skills to work effectively with employees, patients, and external parties.
• Data analysis skills to analyze, interpret and share data in presentation format.
• Familiarity with various types and sources of healthcare information including financial and patient level data files.
• Ability to work independently and in a team environment.
• Proficiency in Microsoft Office applications and other required software.
• Knowledge and understanding of organizational policies, procedures, systems and query handbook.
• Extensive knowledge of complex surgical and clinical diagnostic and CPT coding.
• Ability to utilize CPT Assistant and AHA Coding Clinics and coding guidelines to educate coders on recommended corrections.
• Ability to complete audits in a timely manner.
• Ability to research and answer questions from other departments in a clear and understandable manner.

Additional Details

• Knowledge, Skills and Abilities include extensive regulatory coding knowledge, effective decision making, adaptability, initiative, teamwork, high work standards, communication, customer orientation, interpersonal skills, data analysis, healthcare information knowledge, independent and team work capability, PC skills, and knowledge of policies and procedures.
• Extensive knowledge of complex surgical and clinical diagnostic and CPT coding.
• Ability to utilize CPT Assistant and AHA Coding Clinics and coding guidelines for education.
• Ability to complete audits timely and research questions effectively.

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