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Job Description Summary:
This position assists the HIM/OPG Coding Manager to supervise, monitor, evaluate and train coders in ICD-10/PCS, CPT and HCPCS Level II coding guidelines, modifier guidelines, proper diagnosis and procedure and code selection, documentation guidelines and abstracting for reimbursement, insurance purposes and statistical reports. Understands APR/RVU guidelines.
Responsibilities And Duties:
1. Directly supervises, 12-20 FTE's, across the system, in Coding/Abstraction to include regular monitoring of productivity and performance of all functions within the team to keep within quality and quantity goal ranges. Reports problems and achievements to manager in a timely manner. 2. Performs data quality reviews on professional, outpatient and inpatient encounters to: validate ICD-10-CM/PCS, CPT and HCPCS Level II code assignments, modifiers, APC groupings, missed secondary diagnoses and procedures, and ensure compliance with "Official ICD-10 Coding Guidelines. "In addition, performs data quality reviews on inpatient encounters to validate, ICD-10-CM DRG groupings, missed secondary diagnoses and procedures, and ensure compliance with coding guidelines. 3. Monitors outpatient reports and top 2 5 medical, significant procedure, surgical service and ancillary APC's assigned in the facility to identify shifts and trends in facility's most frequently assigned diagnoses/procedures. If any shifts or trends are identified, evaluates causes of changes. For inpatient monitors case mix reports and top 2 5 medical, significant procedure, surgical service and DRGs assigned in the facility to identify shifts and trends in facility's most frequently assigned DRGs. If any shifts or tends are identified, evaluates causes of changes. For professional, monitors top 2 5 diagnoses/procedures per service line and/or practice. 4. Evaluates quality of documentation to identify incomplete or inconsistent documentation for encounters that will ultimately impact the codes and APC/RVU and DRG assignment. 5. Provides training to health care professionals in ICD-10-CM/PCS, CPT and HCPCS Level II coding guidelines and practices, modifier guidelines, proper documentation guidelines, medical terminology and disease processes. 6. Collects and prepares data for specialized studies e. g. , diagnoses and procedures for a specific time period, service line, case mix studies, and APC management report s . 7. Attends coding and reimbursement workshops and reports to staff on contents. Maintains current information and technologies for coding and reimbursement arena. Meets continuing education requirements for credentialed RHIT, RHIA, and/or CCS, as set by American Health Information Management Associate; or credentialed CPC, COC, CIC as set by American Academy of Procedural Coders. 8. Shows competency in computer applications and use of APC/RVU and DRG Grouping Software and all software and hardware equipment. 9. Performs random UB-04/HCFA 1500 reviews to ensure all codes assigned by Health Information Management Department and/or other designated hospital staff responsible for coding are transferring to UB-04/HCFA 1500 claim form. 10. Monitors and responds to Peer Review Organization PR o or Medicare Integrity Program MI p contractor changes and/or denial letters. Provides documentation to PRO when appealing PRO decision. 1 1. Provides education to appropriate hospital staff on changes to APC/RVU and DRG payment system including annual ICD-10 CM/PCS, CPT and HCPS Level II code changes. 12. Communicates any updates published in Medicare FI newsletter, bulletins and provider manuals. 13. Monitors unbilled accounts reports for outstanding and un-coded outpatient encounters to be completed. 14. Performs other duties as assigned.
Minimum Qualifications:
Associate's Degree (Required)
Additional Job Description:
Bachelor's or Associates degree in health information or related field. Excellent communication skills, leadership, interpersonal and organizational skills OR 3 - 5 yrs coding Experience .
Work Shift:
Day
Scheduled Weekly Hours :
40
Department
Physician Coding
Join us!
... if your passion is to work in a caring environment
... if you believe that learning is a life-long process
... if you strive for excellence and want to be among the best in the healthcare industry
Equal Employment Opportunity
OhioHealth is an equal opportunity employer and fully supports and maintains compliance with all state, federal, and local regulations. OhioHealth does not discriminate against associates or applicants because of race, color, genetic information, religion, sex, sexual orientation, gender identity or expression, age, ancestry, national origin, veteran status, military status, pregnancy, disability, marital status, familial status, or other characteristics protected by law. Equal employment is extended to all person in all aspects of the associate-employer relationship including recruitment, hiring, training, promotion, transfer, compensation, discipline, reduction in staff, termination, assignment of benefits, and any other term or condition of employment
Remote Work Disclaimer:
Positions marked as remote are only eligible for work from Ohio .
