Facility Coding Inpatient DRG Quality Analyst

Banner Health•Prescott Valley, AZ

2d•$29 - $49•Remote

About The Position

In this Inpatient Facility-based HIMS Coding Quality Associate position, you bring your 5 years of acute care inpatient coding background to a team that values growth and development! This is a Quality position, not a day-to-day coding production role but does require coding proficiency and recent Hospital Facility Coding experience. This position is task-production-oriented ensuring quality in the Inpatient Facility Coding department. If you have experience with DRG and PCS coding/denials/audits, we want to hear from you. This position is responsible for the interpretation of clinical documentation completed by the health care team for the health record(s) and for quality assurance in the alignment of clinical documentation and billing codes. Works with clinical documentation improvement and quality management staff to: align diagnosis coding to documentation to improve the quality of clinical documentation and correctness of billing codes prior to claim submission; to identify possible opportunities for improvement of clinical documentation and accurate MS-DRG, Ambulatory Payment Classification (APC) or ICD-10 assignments on health records. Provides guidance and expertise in the interpretation of, and adherence to, the rules and regulations for code assignment based on documentation for all levels of complexity to include accounts encountered in Banner’s Academic, Trauma, high acuity and critical access facilities, as well as specialized services such as behavioral health, oncology, pediatric. Acts as subject matter expert regarding experimental and newly developed procedure and diagnostic coding.

Requirements

Requires a level of education as normally demonstrated by a bachelor’s degree in Health Information Management or experience equivalent to same.
Demonstrated proficiency in hospital coding as normally obtained through 5 years of current and progressively responsible coding experience required.
Requires Certified Coding Specialist (CCS) or Certified Inpatient Coder (CIC) or Certified Professional Coder (CPC) or Certified Outpatient Coder (COC) or Certified Coding Specialist-Physician (CCS-P) or Registered Health Information Technologist (RHIT) or Registered Health Information Administration (RHIA) or other qualified coding certification in an active status with the American Health Information Management Association (AHIMA) or American Academy of Professional Coders (AAPC).
Demonstrated proficiency in hospital coding as normally obtained through 5 years of current and progressively responsible coding experience required.
Must possess a thorough knowledge of ICD Coding and DRG and/or CPT coding principles, as recommended by the American Health Information Management Association coding competencies.
Requires an in-depth knowledge of medical terminology, anatomy and physiology, plus a thorough understanding of the content of the clinical record.
Extensive knowledge of all coding conventions and reimbursement guidelines across services lines, LCD/NCDs and MAC/FIs.
Extensive critical and analytical thinking skills required.
Ability to organize workload to meet deadlines and maintain confidentiality.
Excellent written and oral communication skills are required, as well as effective human relations skills for building and maintaining a working relationship with all levels of staff, physicians, and other contacts.
Must consistently demonstrate the ability to understand the Medicare Prospective Payment System, and the clinical coding data base and indices, and must be familiar with coding and abstracting software, claims processing tools, as well as common office software and electronic medical records software.

Nice To Haves

Additional related education and/or experience preferred.

Responsibilities

Provides guidance on coding and billing, utilizing coding and billing guidelines.
Demonstrates extensive knowledge of clinical documentation and its impact on reimbursement under Medicare Severity Adjusted System (MS-DRG),All Payer Group (APR-DRG) and Ambulatory Payment Classification (APC) or utilized operational systems.
Provides explanatory and reference information to internal and external customers regarding coding assignment based on clinical documentation which may require researching authoritative reference information from a variety of sources.
Reviews medical records.
Performs an audit of clinical documentation to ensure that clinical coding is accurate for proper reimbursement and that coding compliance is complete.
Provides feedback on coding work and trends, and offers suggestions for improvement where opportunities are identified.
Reviews accuracy of identified data elements for use in creating data bases or reporting to the state health department.
If applicable, applies Uniform Hospital Discharge Data Set (UHDDS) definitions to select the principal diagnosis, principal procedure, complications and co morbid condition, other diagnoses, and significant procedures which require coding.
Apply policies and procedures on health documentation and coding that are consistent with official coding guidelines.
Assists with maintaining system wide consistency in coding practices and ethical coding compliance.
If applicable, initiates and follows through on physician queries to ensure that code assignment accurately reflects the patient’s condition, treatment and outcomes.
Identifies training needs for coding staff.
Serves as a team member for internal coding accuracy audits and documents findings.
Acts as a knowledge resource to ancillary clinical departments, patient financial services and revenue integrity analysts regarding charge related issues, processes and programming.
Participates in company-wide quality teams’ initiatives to improve coding and clinical documentation.
Assists with education and training of staff involved in learning coding.
Assists in creating a department-wide focus of performance improvement and quality management.
Assists and participates with management through committees to properly educate physicians, nursing, coders, CDM’s, etc. with proper and accurate coding based on documentation for positive outcomes.
Performs ongoing audits/review of inpatient and/or outpatient medical records to assure the use of proper diagnostic and procedure code assignments.
Collaborates on DRG and coding denials, billing edits/rejections to provide coding expertise to resolve issues and support appropriate reimbursement.
Proficiency in claims software to address coding edits and claim denials utilizing multiple platforms and internal tracking tools.
Provides findings for use as a basis for development of coding education and audit plans.
Maintains a current knowledge in all coding regulatory updates, and in all software used for coding, coding reviews and health information management for the operational group.
Identifies and collects data to allow for monitoring and evaluation of trends in DRG (MS/APR-DRG), APC, HCC, other Heath Risk Adjusted Factors, National Correct Coding Initiative (NCCI) and the effect on Case Mix Index by use of specialized software.
May code inpatient and outpatient records as needed.
Works as a member of the overall HIMS team to achieve goals in days-to-bill.
Works independently under limited supervision.
Uses an expert level of knowledge to provide coding and billing guidance and oversight for all Banner facilities and services they provide.
Internal customers include but are not limited to medical staff, employees, and management at the local, regional, and corporate levels.
External customers include but are not limited to, practicing physicians, vendors, and the community.