Coding Education & Quality Analyst
About The Position
This position conducts professional coding audits of clinical coding records across inpatient, outpatient, observation, emergency department, and all OhioHealth Physician Group (OPG) clinic service lines. The Education and Quality Analyst provides education to physicians, coders, failed claims specialists, and clinical documentation specialists regarding coding, billing, clinical documentation, and coding compliance. The analyst also collaborates with medical staff to address coding queries across all OPG clinic service lines. In addition, the Coding Education and Quality Analyst helps ensure that coding and billing for patient services comply with governmental program requirements and the contractual obligations of non-governmental payers. This position is also responsible for preparing and submitting responses to third-party audits, including those conducted by insurance companies. The analyst evaluates the quality and productivity of new hires and coders who are subject to quality monitoring. Quality-monitoring results are shared with coding management to support performance improvement efforts and, when appropriate, the development of work improvement plans.
Requirements
- High School or GED (Required)
- CCS - Certified Coding Specialist - American Health Information Management Association, CCSP - Cisco Certified Security Professional - CISCO - Computer Information System Company, CPC - CPC Certified Professional Coder - AAPC American Academy of Professional Coders, CPCH - Certified Professional Coder - Hospital - AAPC American Academy of Professional Coders, RHIA - Registered Health Information Administrator - American Health Information Management Association
- Coding Years of Experience 3
Responsibilities
- Conducts facility and charge entry audits of all Hospital, Neighborhood Care, Vascular Interventional Radiology, Rehab and clinic coding records. This includes inpatient, outpatient, observation, emergency department, vascular interventional radiology diagnostic and clinic service lines.
- Works with Clinical Documentation Improvement staff and Data Quality Engineers to ensure accurate capture and reporting of Hospital and Physician Quality Indicators for external reporting purposes.
- Monitors and tracks PQRI reports as applicable to individual practitioners and Operations staff.
- Reviews MediRegs, research of federal regulations, coding rules and regulations, and other reference material.
- Communicates coding and compliance updates to appropriate staff including physicians and management as appropriate.
- Assists Coding Management and Failed Claims with resolution of unbilled and billed claim rejections related to coding and documentation as well as other facility departments regarding coding and charge issues as applicable.
- Ensures encounter forms are updated and compliant.
- Educates physicians, coders, failed claims specialists and clinical documentation specialists on coding, vascular interventional radiology, billing, clinical documentation and coding compliance.
- Communicates coding and compliance updates to all coding staff and failed claims.
- Educates other departments and individuals as necessary regarding coding rules, documentation guidelines and charge issues.
- Primarily responsible for ICD-10 CM/PCS education for entire OhioHealth System.
- Responsible for interacting with medical staff for all coding queries for all Central Ohio Hospitals.
- Assists in development of policies and procedures crossing multiple department lines.
- All other duties as assigned.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
