Employment Type:
Full time
Shift:
Day Shift
Description:
Performs coding quality reviews as outlined in the coding quality plan; such as by coder, service line, focus area and as otherwise necessary to ensure accurate coding and DRG assignment. Develops coder education based on results of coding quality reviews, audit results, and regulatory changes. Provides a high-level of technical competency and serves as a subject matter expert regarding documentation, coding, billing, reimbursement and compliance management as it relates to coding. Assists with denials management, complex case resolution and may perform coding tasks as directedAt the direction of the Regional Manager and Supervisor, Coding, this position is responsible for implementation and ongoing activities of the coding quality and compliance plan for the assigned Regional Health Ministries (RHMs).
Performs coding quality reviews as outlined in the coding quality plan; such as by coder, service line, focus area and as otherwise necessary to ensure accurate coding and DRG or APC assignment. Develops coder education based on results of coding quality reviews, audit results, and regulatory changes. Provides a high-level of technical competency and serves as a subject matter expert regarding documentation, coding, billing, reimbursement and compliance management as it relates to coding. Assists with denials management, complex case resolution and may perform coding tasks as directed.
Coordinates and supports correction of errors occurring with coding systems. Provides coder support via phone or written communications, including in-services and other user group forums. Provides direction for daily coding assignments and operations. Responsible for developing and maintaining coding systems training and process documentation. Assists with training and onboarding of new coding colleagues.
Work may be onsite and/or remote.
ESSENTIAL FUNCTIONS
Knows, understands, incorporates and demonstrates the Trinity Health (TH) mission, vision and values of Trinity Health in leadership behaviors, practices and decisions.
Maintains current knowledge of the MS-DRG system, CCs/MCCs, impact on quality, risk of mortality, severity of illness and CMI as well as ICD-10 coding systems and the guidelines related to Clinical Documentation Integrity. Maintains current knowledge of CPT/HCPCS coding systems and APC assignment.
Provides direction for daily coding assignments and workflow.
Develops and maintains an expert level working knowledge of coding systems, policies, and processes, training courses, materials and certification exercises.
Designs and develops training and education programs that align with end-user needs for components of coding systems and processes.
Coordinates provision of training programs and functions as the trainer/facilitator of coding training programs. Trains and on-boards new coding colleagues.
Provides user support through phone coverage, written updates and communications, user forums and other available tools and methods.
Conducts auditing and monitoring of coding and abstracting completed by coders. Communicates discrepancies in coding and abstracting to the Supervisor and Regional Manager.
Conducts coding quality reviews and reports findings to Supervisor and Regional Manager on a routine basis.
Assists with denials, complex coding cases, claim edits and errors, and may perform coding duties as workflow necessitates.
Serves as the technical resource for coding systems support, testing and training.
Designs, develops and delivers effective educational programs, informational materials and workflow tools that assists the Regional Coding Leadership with integrating compliance into their operations and improving processes and skills.
Maintains professional development and growth by participating as appropriate in continuing educational programs and activities that pertain to healthcare and coding.
Maintains a working knowledge of applicable Federal, State, and local laws and regulations, Trinity Health Corporate Integrity Program, Code of Ethics, as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical, and professional behavior.
MINIMUM QUALIFICATIONS
Must possess advanced knowledge of medical terminology, anatomy and physiology, disease process, and diagnostic and procedural coding, as normally obtained through an Associate’s degree in Health Information Technology, or a related field, or an equivalent combination of years of education and experience in a complex healthcare environment.
At least five (5) years of current hospital-based coding experience is required.
Must be currently certified as one of the following:
Certified Coding Specialist (CCS).
Registered Health Information Administrator (RHIA).
Registered Health Information Technician (RHIT).
Certified Outpatient Coder (COC).
Certified Professional Coder (CPC).
Analytical ability and skill to effectively and efficiently resolve a broad range of coding issues. Critical thinking skills and the ability to work independently with minimal supervision, organize work and set priorities.
Demonstrated experience with use of coding classification systems such as ICD-10 and CPT/HCPCS.
Demonstrated, current expertise with 3M HDM encoders, 3M reporting tools, 3M Computer Assisted Coding (CAC). Working knowledge of Epic EMR preferred.
Comprehensive knowledge of diagnostic and procedural coding principals, conventions, methodologies, and prospective payment systems respective to coding compliance requirements.
Demonstrated ability to interpret coding regulations, guidelines and standards, such as Coding Clinic.
Knowledge of Medical Necessity review guidelines (LMRP/LCD and SI/IS criteria) for commercial, Medicare and Medicaid insurance products. Uses knowledge of insurance criteria and regulations in order to expedite appropriate use of resources and compliance with 3rd party payer contracts.
Demonstrated knowledge of state and federal Hospital Acquired Conditions (HAC) and other applicable quality indicator codes (i.e. PSI, PPI, etc.).
Responds to customer inquiries courteously and timely. Facilitates the resolution of problematic situations related to coding.
Interpersonal skills necessary to effectively interact with the coding team, patients, medical staff, other health ministry departments and any outside agencies.
Intermediate computer skills required, including working knowledge of and experience using MS Word, Excel, Outlook and PowerPoint. Must be able to spend majority of work time utilizing a computer, monitor and keyboard.
Strong understanding of the Catholic health ministry in an evolving health care delivery system and changing reimbursement market.
Personal presence that is characterized by a sense of honesty, integrity, and caring as well as the ability to inspire and to motivate others to promote the philosophy, mission, vision, goals, and values of the Ministry.
PHYSICAL AND MENTAL REQUIREMENTS AND WORKING CONDITIONS
Ability to work in a fast-paced, multi-customer environment, with conflicting needs. May warrant varied and/or extended hours, with changes in workload and priorities to keep pace with the industry and advanced strategic priorities.
Must possess the ability to comply with enterprise policies and procedures.
Must be able to spend majority of work time utilizing a computer, monitor and keyboard.
Must possess a valid driver’s license and be able to travel to assigned Trinity Health sites as needed.
Hourly Pay Range: $32.52 - $48.76
The above statements are intended to describe the general nature and level of work being performed by persons assigned to this classification. They are not to be construed as an exhaustive list of duties so assigned.
Our Commitment
Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.
