HIS - Professional Coding Integrity Specialist - 40 hrs/wk.

Coding Integrity Specialist II

Purpose Of This Position

The quality of work produced by the Coding Integrity Specialists is critical to the success of BVHS as the coded data represents the organization for a variety of purposes. Translation of clinical documentation into coded data must be an accurate and complete representation of the patient's episode of care, which affects quality scores, hospital, and physician profiling, appropriate reimbursement, statistical data reporting and mitigation of compliance risks.

The purpose of the HIS Coding Integrity Specialist II is to assign diagnosis and procedure codes to patient accounts utilizing ICD and/or CPT classification systems, as appropriate. The primary focus of this position is to code Same Day Surgery, Observation, Specialty and may include In-Patient accounts. Proficiency is required in coding Emergency Department, Outpatient Clinicals (Ancillary and/or Professional) accounts as workload requires. Other responsibilities also include abstracting of accounts, resolving claim edits, researching coding issues, querying the physician, and being an active participant on the coding team to insure the highest quality of coded data.

Job Duties/Responsibilities

Duty 1: Utilizes the Encoding system for proper assignment of all diagnosis and procedures ICD and/or CPT codes which is supported by provider documentation. Abstracts all data required by the hospital wide information system and departmental policies.

Duty 2: Meets quality standards. Follows ethical coding practices and regulatory requirements mandated by the Federal Government, regulatory agencies and internal policies. Actively participates in external/internal review activities and departmental education regarding coding and reimbursement. Remains current and apply regulatory/coding changes, as appropriate.

Duty 3: Assesses adequacy of documentation in order to support accurate, complete and specific code assignment of principal and all secondary diagnoses and procedures. Appropriately queries provider for clarification or additional documentation needed. Respond to inquiries regarding coding and reimbursement activities.

Duty 4: Meets departmental productivity standards. Maintains efficient and appropriate balance between coding and support functions. Submits weekly productivity reports to manager or supervisor in a timely manner.

Duty 5: Resolves coding-related edits in a timely manner; completes tracking spreadsheet and updates to billing in edit software. Collects/tracks data for follow-up and education to insure timely coding of accounts and reporting of information, as appropriate

Duty 6: Requests instruction on all equipment systems and software which are unfamiliar or new in order to gain optimum competency. Reports any suspected system issues to appropriate individual/department. Reports any suspected data integrity issues, as appropriate.

Duty 7: Maintains a close working relationship with coding integrity team, Revenue Integrity Team, Patient Financial Services, medical offices, clinical departments, and medical staff. Participates in departmental cross training, quality reviews, and project activities as assigned.

Required Qualifications

• 2-3 years prior experience or satisfactory completion of internal coding assessment required
• Demonstrated knowledge in Medical Terminology, Anatomy & Physiology, Disease Processes/Pathophysiology, Pharmacology required
• Demonstrated knowledge in Coding Guidelines, ICD Diagnosis and Procedure coding, CPT/HCPCS coding, CPT Assistant knowledge required
• Coding ethics knowledge required
• CCA, CPC or CCS required within nine (9) months of hire
• Positive service-oriented interpersonal, communication (verbal and written). Strong organization and time management skills required
• Familiarity with computers and commonly used software applications, including MS Office Suite, internet, electronic health records and encoder software/systems
• Adherence to productivity and quality standards.

Preferred Qualifications

• Prior coding experience in ambulatory and acute care preferred
• RHIA, RHIT, preferred
• Clinical Queries/ Documentation Improvement knowledge preferred (or achieved within first six months of employment)
• Coding Clinic knowledge preferred
• Knowledge in regulatory and general compliance issues, preferred
• Knowledge in reimbursement methodologies preferred
• Training/mentoring capacity preferred

Physical Demands

This position requires a full range of body motion with intermittent walking, lifting, bending, squatting, kneeling, twisting, sitting and standing. The associate will be required to walk for up to one and one-half hours a day, sit for seven hours and stand one-half hour intermittently. The individual must be able to lift ten pounds and reach work above the shoulders. The individual must have good eye-hand coordination and fine finger dexterity. The associate must possess excellent verbal communication skills to perform daily tasks. The associate must have corrected vision and hearing in the normal range.