Coding Quality Reviewer and Educator

Coding Policy And Education Manager

Under the direction of the Manager of Coding Policy and Education, research coding and documentation guidelines and creates/updates policies as needed. Develops Brown University Health training materials, works with Manager to publish materials online and updates materials as needed. Performs audits on schedule or as assigned based on department policy, coding guidelines, payer rules, and/or system policies. Identifies external resources, assists with external audits, records results and schedules related feedback sessions. Works with the manager to provide regularly scheduled education.

Brown University Health employees are expected to successfully role model the organization's values of Compassion, Accountability, Respect, and Excellence as these values guide our everyday actions with patients, customers and one another. In addition to our values, all employees are expected to demonstrate the core Success Factors which tell us how we work together and how we get things done. The core Success Factors include: Instill Trust and Value Differences Patient and Community Focus and Collaborate.

Responsibilities:

• Consistently apply the corporate values of respect, honesty and fairness with the constant pursuit of excellence in improving the health status of the people of the region through the provision of customer-friendly, geographically accessible and high-value services within the environment of a comprehensive integrated academic health system.
• Assume responsibility for knowing and acting in accordance with the principles of the Brown University Health Corporate Compliance Program and Code of Conduct.
• Research coding and documentation guidelines from reliable sources, collects relevant information and compiles that information into a user-friendly manual.
• Records various training materials for coders and providers and works with Manager to publish recorded materials on the Brown University Health Intranet.
• Prepares for and conducts education sessions which include specialty specific coding and documentation guidelines, examples of relevant medical records, resource materials, etc.
• Works with Manager to review findings from external audits and coordinates related feedback sessions with coders, validators and providers.
• Tracks internal and external audits and records on detailed log. Adheres to audit schedule.
• Performs analysis of reports on key coding/auditing metrics.
• Identifies trends and reports those trends to the Manager.
• Assists Manager with ROI analyses.
• Stays abreast of all coding updates, including new/deleted ICD-10 codes, new/deleted CPT codes, new/deleted HCPCS codes and any coding guideline changes.
• Reviews payer updates and notifies Manager of any pertinent changes impacting coding/documentation.
• Creates all components of a successful education process, including lesson planning and materials used for educational purposes (i.e. audiovisual aids, Epic Tips sheets, knowledge retention exams, etc.).
• Assists with educating validators/coders as requested.
• Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association and the American Association of Professional Coders.
• Monitors validators for violations and reports to PFS Manager or Director when areas of concern are identified.
• Maintains confidentiality of sensitive information at all times.
• Participates in various committees, task forces and quality improvement teams as needed.
• Performs other duties as necessary.

Minimum Qualifications:

Basic Knowledge: Associate degree or 3 years of experience in a medical coding/validating role. Certification required: CCS, CPC, RHIA or RHIT considered. Specialty certification a plus or willingness to obtain specialty certification. Excellent verbal and written communication skills with technical proficiencies to include Microsoft Excel &PowerPoint, and Teams applications.

Experience: Three to five years progressively responsible experience performing outpatient coding. Experience in a large, multispecialty physician group and/or complex academic medical center preferred. Experience should demonstrate a high level of knowledge in ICD-10-CM and CPT-4 coding methodologies. Experience with Epic preferred.

Independent Action: Performs independently within the department's policies and procedures. Refers specific complex problems to the Manager when clarification of the departmental policies and procedures are required. Must be able to work with minimal supervision.

Work Environment and Physical Requirements: Remote work from home.

Supervisory Responsibility: None