Coding Quality Specialist I - Coding

Summary :

The Coding Quality Specialist reports to the HIM Coding Education Manager to perform internal departmental coding reviews in support of the Coding Operations Department’s business needs. This position contributes to coding education and training and facilitates pre-bill and cross-training in order to advance and keep current, the skillset of our HB coding associates.

The Coding Quality Specialist demonstrates high caliber specialty knowledge and understanding of current ICD-10-CM, ICD-10-PCS and / or CPT / HCPCS coding guidelines and practices in both the inpatient and outpatient care settings, maintaining a 95% accuracy rate.

Assignments are based on departmental needs and include but are not limited to PEPPER reviews, new hire and standard pre-bill reviews, remediation and performance improvement reviews and those required for corrective action plans, query quality and other focused reviews as may be needed. The Coding Quality Specialists will review for quality in regards to POA assignment, principal and secondary diagnosis code assignment, procedural coding, modifier usage, discharge disposition verification, query opportunities and DRG and APC accuracy.

Coding Quality Specialist will work collaboratively with various CHRISTUS Health Departments, including but not limited to the Regional Coding Managers, HIM, Compliance, and Clinical Documentation Specialist to ensure feedback is shared and reported for education and training purposes. The Coding Quality Specialist will also assist in production coding as may be required and in order to keep current skills up-to-date and accustomed to changing technology and workflows.

The Coding Quality Specialist will report directly to the HIM Coding Education Manager, with additional leadership from the Director of Coding Operations and System HIM Director.

Responsibilities :

• Meets expectations of the applicable OneCHRISTUS Competencies : Leader of Self, Leader of Others, or Leader of Leaders.
• Facilitate and complete inpatient and outpatient coding reviews.
• Communicates findings both verbally and in writing in an approved, appropriate format to support training and education such as would be reported in Coding Roundtables or Section Meetings.
• Assist with development and coordination of review plans, feedback to coding staff and management to include query opportunities, documentation opportunities, accurate code assignment (ICD, CPT, HCPCS), accurate payment groupings (DRG, APC), accurate modifier assignment, accurate POA assignment, accurate discharge disposition assignment, compliance and data management.
• Assist with chart sample selection for reviews and randomization to be coordinated with Coding Managers.
• Assist with finalizing an annual work plan for targeted chart reviews and pre-bill reviews.
• Work collaboratively with Coding Integrity Department to recommend and assist with content and examples that may be used to develop Job Aides, Coding Best Practice references and other assisting resources to support and advance coder knowledge and expertise. Reviews results and performs trend analyses to identify patterns and variations in coding practices and / or case-mix index which require education.
• Meets or exceeds an accuracy rate of 95%.
• Ensure coding reviews are appropriate and effective. Assesses effectiveness through associate evaluations.
• Has strong written and verbal communication skills.
• Able to work independently in a remote setting, with minimal supervision.
• All other work duties as assigned by Manager.

Job Requirements : Education / Skills

High school diploma or equivalent years of experience required.

Completion of accredited Baccalaureate Health Informatics or Health Information Management or an AHIMA approved Coding Certificate Program, preferred.

Experience

Five (5) or more years of Inpatient and / or Outpatient HB coding experience in an acute care setting preferred.

Licenses, Registrations, or Certifications

Registered Health Information Administrator (RHIA) (AHIMA) required.

Registered Health Information Technician (RHIT) (AHIMA) required.

Certified Coding Specialist (CCS) (AHIMA) required.

Work Schedule : 5 Days - 8 Hours

Work Type : Full Time

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