Coding Educa & Quality Analyst

OhioHealth•WORK AT HOME - OHIO, OH

About The Position

The Coding Education and Quality Analyst conducts professional coding audits across inpatient, outpatient, observation, emergency department, vascular interventional radiology, rehabilitation, and clinic service lines. The analyst provides education to physicians, coders, failed claims specialists, and clinical documentation specialists on coding, billing, clinical documentation, and coding compliance, and collaborates with medical staff on coding queries. The role helps ensure patient-service coding and billing comply with governmental program requirements and non-governmental payer contracts, and prepares and submits responses to third-party audits, including insurance company audits. The analyst evaluates quality and productivity for new hires and coders subject to quality monitoring, shares results with coding management to support performance improvement and work improvement plans, and assists with policy and procedure development.

Requirements

High school diploma or GED.
Three years of experience.
One or more listed coding credentials: CCS, CCSP, CPC, CPCH, or RHIA.

Responsibilities

Conduct facility and charge-entry audits of hospital, Neighborhood Care, vascular interventional radiology, rehabilitation, and clinic coding records.
Work with Clinical Documentation Improvement staff and Data Quality Engineers to support accurate capture and reporting of Hospital and Physician Quality Indicators for external reporting.
Monitor and track PQRI reports as applicable to practitioners and Operations staff.
Review MediRegs, federal regulations, coding rules and regulations, and other reference material; communicate coding and compliance updates to appropriate staff, physicians, and management.
Assist Coding Management and Failed Claims with coding- and documentation-related unbilled and billed claim rejections, and assist other facility departments with coding and charge issues.
Ensure encounter forms are updated and compliant.
Educate physicians, coders, failed claims specialists, clinical documentation specialists, and other departments on coding, vascular interventional radiology, billing, clinical documentation, coding compliance, documentation guidelines, and charge issues.
Provide ICD-10 CM/PCS education for the OhioHealth System.
Interact with medical staff regarding coding queries for Central Ohio Hospitals.
Assist in developing policies and procedures across multiple department lines.
Prepare and submit responses to third-party audits, including insurance company audits.
Evaluate the quality and productivity of new hires and coders subject to quality monitoring, and share monitoring results with coding management to support performance improvement and work improvement plans.
Perform other duties as assigned.