Hospital Coding Reviewer/ Educator- Inpatient

Job Title

Multifacility Coding Specialist

Job Description

Multifacility responsibility for ensuring all aspects of coding is carried out accurately and efficiently through chart reviews, problem account resolution, and coding education according to established rules and regulatory guidelines across Orlando Health System.

Responsibilities

Essential Functions

• Performs focused review for accuracy of principal and secondary diagnoses, co-morbid conditions and complications, procedure code assignments, and other required abstracted elements according to provider documentation in the medical record for to ensure billing compliance, quality reporting, and optimal reimbursement for all hospitals across Orlando Health System.
• Maintains and achieves the highest standards of coding quality by assigning accurate ICD-10-CM and ICD-10-PCS or CPT-4 codes utilizing an electronic encoder application in accordance with hospital policy and regulatory body guidelines.
• Subject matter experts on coding guidelines and responds promptly to internal and external requests to provide feedback on coding related issues
• Participates and provides expert feedback during coding section meetings and coding education in services as well as takes initiative to assist others and shares knowledge with the appropriate stakeholders.
• Develops and presents educational materials to key stakeholders to support accurate and compliant coding.
• Interacts and communicates effectively with coders, physicians, physician extenders, physician offices and members of the coding and management team.
• Collaborates with manager and other members of the Revenue Management Team to review all necessary patient records for accurate coding for best practice.
• Identify trends from review findings and formulate recommendations for corrective action plans and submit to Leaders from for Key Performance Indicator (KPI) reporting, process improvement, and education.
• Able to identify areas of focus for review through trend reporting analysis.
• Assists with Discharge Not Final Billed (DNFB) account reviews to ensure timely code completion and accurate billing for multi-hospital accounts.
• Maintains and achieves department standards of abstracting quality by reviewing accurate discharge disposition, to achieve the highest quality of entered data.
• Acts as a team leader and support for regional manager.
• Assist with system testing, reporting, data trending, and troubleshooting coding applications.
• Serves as a preceptor to new coders.
• Responds promptly to internal and external requests to provide feedback on coding related issues.
• Complies with the Standards of Ethical Coding as set forth by the American Health Information Management Association (AHIMA), American Academy of Professional Coders (AAPC), and adheres to official guidelines.
• Attends departmental and interdepartmental meetings as required.
• Utilizes resource material available in department to support coding practices.
• Performs other duties as needed.
• Maintains reasonably regular, punctual attendance consistent with Orlando Health policies, the ADA, FMLA and other federal, state, and local standards.
• Maintains compliance with all Orlando Health policies and procedure.

Inpatient Liaison – Hospital inpatient

• Advanced level of knowledge of sequencing guidelines for the sequencing of diagnosis and procedure codes for appropriate classification systems with knowledge of ICD-10, ICD-10 PCS, MS-DRG and APR-DRG.
• Demonstrates strong understanding of mortality and other coding impacted quality initiatives, and key performance indicators.
• Collaborates with Clinical Document Excellence (CDE), Quality Management and other departments to determine appropriate DRG assignments for compliance and reimbursement purposes.
• Assist in coding any Inpatient as needed.

Outpatient Liaison – Hospital outpatient

• Advanced level of knowledge of experience with ICD-10 and CPT coding.
• Advanced level of knowledge of NCCI and external payer edit resolution.
• Assist in coding any outpatient cases as needed.

Radiation Oncology Liaison – Hospital and Outpatient

• Advanced knowledge of experience with ICD-10 and CPT coding in the radiation oncology field is required.
• Advanced level knowledge of radiation oncology modalities and billing rules.
• Advanced skill level in radiation oncology modality procedure charge validation (CPT Code) based on actual chart documentation.
• Advanced skill level in reading treatment plans to identify the number of MUEs and devices.

Other Related Functions

• Develops and updates internal departmental processes.
• Assumes the responsibility for professional growth and development through educational programs, research, etc.
• Maintains certification status.
• Performs other related duties as assigned.
• Maintains 95% or above accuracy rate.
• Strong computer literacy including Microsoft Word and Excel experience.

Qualifications

Education/Training

• Associate's or bachelor's degree in Health Information Management; OR
• Completion of coding certificate program
• Thorough knowledge of official coding guidelines as per AMA, AHA, and CMS.
• Computer literacy, knowledge of Anatomy, Physiology and Medical Terminology required
• Liaison coding skills test of 90% or better
• Advanced level knowledge of anatomy, physiology, pathophysiology, pharmacology, and medical terminology to accurately translate medical record documentation into the appropriate classification system for reporting purposes

Licensure/Certification

• One of the following national certifications:
• Certified Coding Specialist (CCS), Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT) through AHIMA
• Certified Professional Coder (CPC) through the American Academy of Professional Coders
• Certified Outpatient Coder (COC)

Experience

• Inpatient and Outpatient Liaisons:
• Seven (7) years of relevant hospital inpatient and/or outpatient coding experience required.
• One (1) year of teaching hospital coding experience preferred.
• Radiation Oncology Liaison Only:
• Three (3) years of Radiation Oncology coding experience in lieu of teaching hospital experience required (Radiation Liaison Only)