Coding Quality & Edu Spec 1 / HIM Coding

Hartford Healthcare•Newington, CT

About The Position

The creation of the HHC System Support Office recognizes the work of a large and growing group of employees whose responsibilities are continually evolving so that we and our departments now work on behalf of the system as a whole, rather than a single member organization. With the creation of our new umbrella organization we now have our own identity with a unique payroll, benefits, performance management system, service recognition programs and other common practices across the system. JOB SUMMARY and RESPONSIBILITIES: Auditing Validates International Classification of Diseases, Tenth Edition, Clinical Modification (ICD-10-CM) diagnoses and ICD-10-PCS (Procedural Classification System) or Current Procedural Terminology(CPT) codes and resulting DRGs/APCs to ensure consistency and efficiency in claims processing, data collection, and quality reporting for HHC Validates Home Health Coding/OASIS reviews. Prepares written reports on the results of the audits, including recommendations for improvement and compliance with state and federal laws, regulations and policy. Presents audit reports, results and action plans to coding management for discussion and plan for dissemination to coders. Presents quarterly Key Performance Indicators (KPI) to compliance office Responsible for managing CHIME (Connecticut Health Information and Management Exchange) and Premier system edits Utilize Cobius Institutional Audit Manager (IAM) software to streamline audits, communicate findings, and simplify reports. Education/Training Provides feedback and creates focused educational/training programs on the results of auditing and monitoring activities for coders, CDS and providers as appropriate Provides Coder, CDS staff and provider education on changes in regulations related to coding. Provides coding feedback on complex cases. Communication Insures the appropriate dissemination and communication of all regulation, policy, and guideline changes (eg. Code updates, coding guidelines, Local Coverage Determinations (LCD), Transmittals) to affected personnel. Maintains system folders with coding policies, procedures, educational articles and coding compliance materials. Other Participates in the development and review of HIM Coding Policy and Procedures. Participates in general or special assignments and other duties as assigned Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association and adheres to official coding guidelines This position reports to Manager Hospital HIM Coding Quality and Education

Requirements

Associates Degree or equivalent experience
Four or more years of progressive on-the-job coding experience in an acute care hospital.
CCS or CPC certification
For Home Health Hospice: Home Health Coding Specialist – Diagnosis (HCS-D) and/or Home Care Coding Specialist – Hospice (HCS-H) Home Health Clinical Specialist - OASIS (HCS-O) or OASIS Specialist – Certified (COS-C)
Strong written and verbal communication skills.
Solid analytical capabilities.
Good organizational skills.
Critical thinking, problem solving and deductive reasoning skills.
Knowledge of: Comprehensive understanding of ICD-10-CM diagnosis and ICD-10-PCS and/or CPT/HCPCS operative procedure codes
Understands the Uniform Hospital Discharge Data Set (UHDDS)
Understands MS-DRGs, APCs and/or Outpatient Code Edits (OCE) and Correct Coding Initiative (CCI) edits
IRF-PAI (IP Rehabilitation) Home Health understands: PDGM payment model OASIS
Working knowledge of clinical information
Extensive knowledge of state, federal and Medicare regulations related to coding
Basic knowledge of the revenue cycle for the purpose of communicating corrective action recommendations
Microsoft Office Products; Word, Excel Encoder and/or Computer Assistant Coding (CAC) HROI and Cobius
Function independently.
Handle multiple priorities.
Listen and acknowledge ideas and expressions of others attentively.
Converses clearly using appropriate verbal and body language.
Collaborate with others to achieve a common goal through mutual cooperation.
Influence others for positive and productive outcomes.

Responsibilities

Auditing Validates International Classification of Diseases, Tenth Edition, Clinical Modification (ICD-10-CM) diagnoses and ICD-10-PCS (Procedural Classification System) or Current Procedural Terminology(CPT) codes and resulting DRGs/APCs to ensure consistency and efficiency in claims processing, data collection, and quality reporting for HHC
Validates Home Health Coding/OASIS reviews.
Prepares written reports on the results of the audits, including recommendations for improvement and compliance with state and federal laws, regulations and policy.
Presents audit reports, results and action plans to coding management for discussion and plan for dissemination to coders.
Presents quarterly Key Performance Indicators (KPI) to compliance office
Responsible for managing CHIME (Connecticut Health Information and Management Exchange) and Premier system edits
Utilize Cobius Institutional Audit Manager (IAM) software to streamline audits, communicate findings, and simplify reports.
Provides feedback and creates focused educational/training programs on the results of auditing and monitoring activities for coders, CDS and providers as appropriate
Provides Coder, CDS staff and provider education on changes in regulations related to coding.
Provides coding feedback on complex cases.
Insures the appropriate dissemination and communication of all regulation, policy, and guideline changes (eg. Code updates, coding guidelines, Local Coverage Determinations (LCD), Transmittals) to affected personnel.
Maintains system folders with coding policies, procedures, educational articles and coding compliance materials.
Participates in the development and review of HIM Coding Policy and Procedures.
Participates in general or special assignments and other duties as assigned
Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association and adheres to official coding guidelines