Serves as a lead analyst for the St. Luke’s Hospital 3M 360 Encompass coding system and other coding quality systems. Responsible for development, re-engineering, and system enhancement projects. Performs system and/or staff audits across outpatient hospital and/or ambulatory coding. Maintains databases, spreadsheets, computer and paper files related to coding activities and regulations. Responsible for reporting and proactive analytical support related to coding and reimbursement systems. Responsible for ensuring that systems are designed for optimal and pliant code assignment, including building/maintaining system code sets and tables. Troubleshoot system/program issues and ensure accuracy and efficiency of work flow. Works effectively with physicians, medical group managers and staff, Patient Financial Services, Information Services, Health Information Services, clinical departments, Finance, third-party payers, vendors and other external customers to resolve issues and optimize processes in a professional manner. Responsible for development of user training manuals and performing coding related training of physicians, office staff, and hospital staff. Resource for extensive analytical projects related to coding and charge assignment in the acute outpatient and ambulatory settings. Proficient in the use of a variety of reporting tools including 3M, Cerner, coding edit and chargemaster software systems. Uses reporting capabilities to assist in decision making with process implementation or improvements.
Principle Accountabilities: % of Time Spent
1. Develops and performs coding system audits, system enhancements, re-engineering workflows across the outpatient hospital and ambulatory coding settings. (35%)
2. Maintains coding quality reviews, databases, spreadsheets, computer and paper files. Provides proactive analytical support related to coding systems and coding quality (35%)
3. Ensures systems are designed for optimal and compliant code assignment. Performs a variety of reporting using 3M and Cerner reporting tools. (10%)
4. Designs and uses audit tools to monitor the accuracy of clinical coding. Troubleshoots system/program issues and ensures accuracy and efficiency of workflows. (8%)
5. Creates and updates training material in response to regulatory updates. Performs training of physicians, office staff and hospital staff on coding rules and regulatory requirements. (6%)
6. Leads extensive analytical projects related to coding and charge assignment in the ambulatory settings. (4%)
7. Continuously evaluates the quality of clinical documentation to spot incomplete or inconsistent documentation for ambulatory encounters impact code selection and result in payment groups as well as payment. Brings identified concerns to medical staff committee, physicians, or department managers for resolution (ongoing)
8. Analyzes trends in documentation improvement opportunities various outpatient settings. (ongoing)
9. Abides by the Standards of Ethical Coding as set for by AHIMA and monitors coding staff for violations. Reports concerns to HIS Director or Corporate Compliance Officer if needed. (ongoing)
10. Demonstrates competency in the use, maintenance and development of computer applications including DRG, APC, RVU grouper software and hardware currently used by the Health Information Services Department. (ongoing)
6. All other duties as assigned. (2%)
Knowledge, Skills, and Abilities:
Effective written and verbal communication, presentation and training skills
Excellent critical thinking, creative problem solving and conflict management skills
Proficient organization and planning skills.
Strong computer and statistical reporting skills.
PowerPoint, Excel, 3M software, and Encoder experience.
Demonstrated knowledge of quality improvement theory and practice.
Works independently with minimal supervision
Employee is required to sit frequently, stand and walk frequently. Frequent computer work is also required. Employee must lift/carry a light (1-15 lbs) load occasionally. For repetitive action, employee is required to use both hands for simple grasping, pushing/pulling, and fine manipulation. Employee is exposed to normal office environment where there is no discomfort due to temperature changes, dust, noise and the like.
(Occasionally: 1-33%, Frequently: 34-66%, Continuously: 67-100%)
The most significant of duties are included but this does not exclude occasional work assignments not mentioned or developmental duties.
Associate’s degree in health services discipline with formal HIM education
