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 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 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.
• Meets all educational requirements as stated in current Company policy.
• 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 an annual education needs assessment as input to the strategic coding education program and provides this assessment to the Coding Leadership team.
• 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 regularly scheduled coding meetings and as needed.
• Researches external sources for common coding trends and questions.
• Works on special projects as assigned.
• Applies adult learning concepts when developing, delivering or assisting others for educational programs.
• Provides high level of customer service.
• Practices and demonstrates adherence to the Company’s Code of Conduct and ethics philosophy and Company’s Mission and Values.
• Completes other duties as assigned.

Job Requirements

• Extensive regulatory coding knowledge including ICD-10-CM, ICD-10-PCS, CPT-4, Modifiers, MS-DRGs, POA assignment, and where applicable APR-DRGs and APCs.
• Effective decision making skills relating and comparing; securing relevant information and identifying key issues; committing to action after developing alternative courses of action considering resources, constraints, and organizational values.
• Adaptability to major changes in work responsibilities or environment; adjusting effectively to new work structures, processes, requirements, or cultures.
• Initiative - independently takes prompt proactive steps toward problem resolution.
• Ability to contribute to team success by actively participating as a member of the team to move toward completion of goals.
• Work standards - setting high standards of performance for self and others; assuming responsibility and accountability for successfully completing assignments or tasks; self-imposing standards of excellence.
• Clear and concise communication skills, both verbal and written.
• Customer orientation - establishes and maintains long-term customer relationships, building trust and respect by consistently meeting and exceeding expectations.
• Interpersonal skills - able to work effectively with other employees, patients, and external parties.
• Data analysis skills - able to analyze, interpret and share data in presentation format.
• Knowledge of healthcare information - familiar with various types and sources of healthcare information, including financial and patient level data files.
• Ability to work independently and experience working in a team environment.
• Proficiency in Microsoft Office applications and others as required.
• 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, ability to work independently and in teams, PC skills, and knowledge of policies and procedures.

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