Job Description

Job Description

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 resulting in appropriate reimbursement and data integrity.
• Coordinates and directs day-to-day coding educational activities.
• Facilitates and provides coding educational classes/presentations to staff as required.
• Communicates outcomes to the coding team to improve accuracy, integrity, and quality of patient data and physician documentation.
• Assists Coding Leadership in root cause analysis of coding quality issues, performs account reviews, and prepares training documents for coding quality action plans.
• Responds to coding-related questions from HSC coding staff.
• 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 per policy on special projects.
• Researches coding opportunities and escalates as needed.
• Assists in review, improvement of processes, education, troubleshooting, and 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 to coding guidelines and policy.
• Demonstrates expert level knowledge of medical coding practices and concepts.
• Participates in special reviews or projects.
• Maintains or exceeds 95% productivity and accuracy standards.
• Meets all educational requirements as stated in current Company policy.
• Reviews official data quality standards, coding guidelines, Company policies, procedures, and clinical/medical resources to keep coding knowledge 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 in skill development.
• Provides skilled coding support through scheduled meetings and as needed.
• Researches external sources for common coding trends and questions.
• Applies adult learning concepts in educational programs.
• Provides high level of customer service.
• Adheres to Company’s Code of Conduct, ethics philosophy, Mission and Values.
• Performs other duties as assigned.

Job Requirements

• Extensive regulatory coding knowledge including ICD-10-CM, ICD-10-PCS, CPT-4, Modifiers, MS-DRGs, POA assignment, APR-DRGs, and APCs.
• Effective decision making skills involving securing relevant information and identifying key issues.
• Adaptability to major changes in work responsibilities or environment.
• Initiative to independently take proactive steps toward problem resolution.
• Ability to contribute to team success and actively participate as a team member.
• High work standards and accountability for completing assignments successfully.
• Clear and concise verbal and written communication skills.
• Customer orientation with ability to build long-term relationships and trust.
• Interpersonal skills to work effectively with employees, patients, and external parties.
• Data analysis skills to 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.

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.

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