Responsible for ensuring accuracy and quality coding assignments for all records requiring DRG and/or APC coding; ensures optimal and timely reimbursement.

Principal Duties and Responsibilities (*Essential Functions)

1. Performs comprehensive pre-billing coding audits, through the use of eValuator, to ensure claims are accurately coded and charged in compliance with coding and regulatory standards.

2. Performs comprehensive pre-billing coding data quality reviews on inpatient and/or outpatient records to ensure proper coding guidelines have been followed and appropriate DRG (MS/APR) or APC assignments have been made for appropriate reimbursement.

3. Responsible for completion of reviews within 72 hrs of import date to include new reviews of up to or exceeding 12 to 15 per day for inpatients and/or completion of reviews within 48 hrs of import date including up to or exceeding 50 per day for outpatient accounts.

4. Maintains an audit response turnaround time of 24 to 48 hours, with the exception of weekends.

5. Reviews abstracted data to ensure quality of required data elements (facility specific elements) including appropriate discharge disposition.

6. Responsible for maintaining coded data quality through ongoing quality review and assessment of outpatient and/or inpatient records.

7. Serves as a subject matter expert on ICD 10-CM/PCS and/or CPT/HCPCS coding guidelines and policies.

8. Coaches and educates coding staff to ensure staff adheres to ICD 10-CM/PCS, CPT/HCPCS coding guidelines and policies.

9. Maintains working knowledge of CMS (Medicare and Medicaid) regulations, Local Coverage Determinations (LCD), National Coverage determination (NCD) and National Correct Coding Initiatives (NCCI).

10. Communicates quality audit results and recommendations to management in a clear and concise manner

11. Performs ad hoc quality reviews and audits as requested by management.

12. Participates in team meetings with coding staff to discuss coding problems, changes, or issues.

13. Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association and monitors coding staff for violations and reports to leadership when areas of concern are identified
14. Performs other duties as needed and/or assigned.

Job Specific (Minimum Requirements)

Knowledge, Skills, and Abilities

• Demonstrates working knowledge of the English language, verbal and written.
• Prior history as Clinical Documentation Specialist role, leadership skills, helpful.
• Demonstrates basic understanding of coding guidelines.
• Requires course work in/knowledge of medical terminology, anatomy and physiology, pathophysiology in order to interpret data on patient documentation. Working knowledge of all areas of adult medicine.
• Demonstrates strong interpersonal and communication skills necessary to interact effectively with all internal and external customers, verbally and in writing, as required.
• Requires strong organizational and analytical skills in order to prepare and maintain various documentation/reports.
• Demonstrates the knowledge and understanding of intensity of service, severity of illness, opportunities for intervention, planned course of treatment/procedures, care needs, and outcome goals.
• Requires excellent observation skills, analytical thinking, and problem solving ability.Requires strong critical thinking skills, ability to assess/evaluate/teach.

Education

Associates Degree in Health Information Technology is Required.

Bachelors Degree in Health Information Technology is Preferred.

Experience

Inpatient Coding/Clinical documentation review is Preferred.

3 yrs of Coding/Clinical documentation Improvement is Preferred.          

Certifications and Licensures                     

RHIT/RHIA certification is Required.

Model of Care and Conduct

Methodist Hospitals strives for excellence and insists on high standards of conduct and performance in everything we do. Our Model of Care and Conduct is designed to create a positive work environment which Methodist desires for all employees. This is foundational to the high level of patient, family and physician satisfaction we strive for each day. As part of all position’s duties at Methodist Hospitals, all employees are responsible to conduct themselves in accordance with the Model of Care and Conduct and will be evaluated according to these standards of behavior.