Coding Inpatient Quality Reviewer / Educator (Work From Home)

Position Title :

Coding Inpatient Quality Reviewer / Educator (Work From Home)

Department : HIM Coders

Job Description :

This position may be performed remotely anywhere within the United States except the States of Arizona, California, Connecticut, Illinois, New Jersey, New York, Pennsylvania, or Washington D.C.

General Description :

Performs internal quality assessment reviews on OUMS coders to ensure compliance with national coding guidelines and the OUMS coding policies for complete, accurate and consistent coding which result in appropriate reimbursement and data integrity. Helps to coordinate and direct the day-to-day coding educational activities. Facilitates and provides coding educational classes / presentations to staff, as required / when needed. Communicates outcomes to the coding team to improve the accuracy, integrity and quality of patient data, to ensure minimal variation in coding practices and to improve the quality of physician documentation within the body of the medical record to support code assignments. Responsibilities also include assisting Coding Leadership in root cause analysis of coding quality issues, performing account reviews, and preparing training documents to assist with coding quality action plans.

Essential Responsibilities :

Responsibilities listed in this section are core to the position. Inability to perform these responsibilities with or without an accommodation may result in disqualification from the position.

• Responds to coding-related questions from HSC coding staff
• Leads, coordinates and performs all functions of quality reviews (routine, pre-bill, policy driven and incentive plan driven) for inpatient and outpatient coding across OUMS
• Provides Coding Integrity Specialist (CIS) and CQR education as needed
• Initiates the rebilling process as required per policy on special projects
• Researches coding opportunities and escalate as needed
• Assists in the review, improvement of processes, education, troubleshooting and recommend prioritization of issues.

Provides and creates education as needed

Monitors QA results to assist Coding Leadership in root cause analysis and educational opportunities

Performs an annual education needs assessment as input to the strategic coding education program and provides this assessment to the Coding Leadership team

General Responsibilities :

Minimum Qualifications

Education : High School graduate or GED equivalent required, undergraduate (associates or bachelors) degree in HIM / HIT preferred.

Experience : Proven work experience in areas of coding education strongly preferred. Minimum of 5 years acute care inpatient / outpatient coding experience required. Minimum of 3 years coding auditing / monitoring experience strongly preferred.

Licensure / Certifications / Registrations Required : RHIA, RHIT, CCS, or CPC required

Knowledge, Skills and Abilities :

extensive regulatory coding, (ICD-10-CM, ICD-10- PCS, CPT-4, Modifiers, MS-DRGs, POA assignment and where applicable APR-DRGs and APCs) and associated reimbursement knowledge

relating and comparing; securing relevant information and identifying key issues; committing to an action after developing alternative courses of action that take into consideration resources, constraints, and organizational values

independently takes prompt proactive steps toward problem resolution

toward the completion of goals

Communication

communicates clearly and concisely, verbally and in writing.

establishes and maintains long-term customer relationships, building trust and respect by consistently meeting and exceeding expectations.

able to work effectively with other employees, patients and external parties.

able to analyze, interpret and share data in a presentation format.

familiar with various types and sources of health care information, including financial and patient level data files.

demonstrates proficiency in Microsoft Office applications and others as required.

demonstrates knowledge and understanding of organizational policies, procedures, systems and query handbook.

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OU Health is an equal opportunity employer. We offer a comprehensive benefits package, including PTO, 401(k), medical and dental plans, and many more. We know that a total benefits and compensation package, designed to meet your specific needs both inside and outside of the work environment, create peace of mind for you and your family.

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