Purpose of Position:
This class of positions encompasses supervisory and/or administrative work of varying degrees of difficulty and responsibility in the field of health information management. Performs quality review of records and/or documentation provided by clinical staff. Contributes to, and ensures the appropriateness of code and Diagnosis-Related Group (DRG) assignment in order to facilitate consistency, accuracy, and efficiency in claims processing, data collection, and quality reporting. All personnel perform related work.
Under general supervision, directs, coordinates, and supports the daily activities and services in an assigned department(s), unit(s) or area of service.
Examples of Typical Tasks:
At a more difficult and responsible level, performs the duties of Assignment Level I:
1. Validates the completeness, accuracy, and specificity of code assignments for inpatient, outpatient, and ambulatory surgery records in accordance with established coding guidelines. Ensures that all documented diagnoses and procedures are properly coded.
2. Validates the accuracy of DRG assignment.
3. Validates the accuracy of additional information abstracted from the clinical record.
4. Monitors denials and appeals. Performs DRG denial reviews for appropriate parties. Ensures that denials are responded to in a timely manner; submits monthly reports.
5. Monitors data integrity and accuracy; makes necessary data corrections and entry. Performs chart review to determine data quality.
6. Identifies and reports on cases with documentation inadequacies, inconsistencies, and other issues with opportunities for improvement. Evaluates root causes and proposes corrective action for same.
7. Generates physician queries as needed in order to obtain clarification of medical record documentation. Validates that physicians have been queried according to established procedure.
8. Confers with coding specialists, and oversees and evaluates work performance. Provides ongoing and specific feedback to coding staff and management team regarding review findings.
9. Provides education and training to new and existing health information management staff.
10. Instructs physicians, nurses, health information management staff, and other appropriate personnel regarding documentation requirements as related to coding.
11. Works with other departments to ensure that accurate reporting and reimbursement are facilitated.
12. Assigns codes for diagnoses and procedures according to the current classification system for inpatient, outpatient, and ambulatory surgery records and in accordance with established coding guidelines.
13. Performs concurrent and retrospective clinical documentation review and provides data when necessary.
14. Reviews and analyzes clinical records for compliance with appropriate regulatory requirements.
15. Effectively utilizes computer applications and other coding and abstracting software and hardware as necessary.
16. Performs other related duties as assigned or directed.
In addition to performing the duties of Assignment Level I at a more difficult and responsible level, as described above, also performs the following:
1. Assists in the development, implementation, and management of organizational strategy, initiatives, and/or budget and performance standards; communicates organizational objectives and goals.
2. Serves as departmental representative through participation in various facility and corporatewide committees, work groups, and/or initiatives.
3. Assists in interdisciplinary efforts to review existing documentation and coding policies and procedures and makes necessary recommendations for improvement.
4. May assume responsibility for supervising and/or directing assigned personnel as appropriate and required.
