Inpatient Coding Quality Reviewer/Educator (Work From Home)
Inpatient Coding Quality Reviewer/Educator
(Work From Home)
OU Medicine - Oklahoma City, OK
Performs internal quality assessment reviews on OUMS coders to ensure compliance with national coding guidelines and the OUMS coding policies for complete, accurate and consistent coding which result in appropriate reimbursement and data integrity. Helps to coordinate and direct the day-to-day coding educational activities. Facilitates and provides coding educational classes/presentations to staff, as required/when needed. Communicates outcomes to the coding team to improve the accuracy, integrity and quality of patient data, to ensure minimal variation in coding practices and to improve the quality of physician documentation within the body of the medical record to support code assignments. Responsibilities also include assisting Coding Leadership in root cause analysis of coding quality issues, performing account reviews, and preparing training documents to assist with coding quality action plans.
Responsibilities listed in this section are core to the position. Inability to perform these responsibilities with or without an accommodation may result in disqualification from the position.
Responds to coding-related questions from HSC coding staff
Leads, coordinates and performs all functions of quality reviews (routine, pre-bill, policy driven and incentive plan driven) for inpatient and outpatient coding across OUMS
Provides Coding Integrity Specialist (CIS) and CQR education as needed
Initiates the rebilling process as required per policy on special projects
Researches coding opportunities and escalate as needed
Assists in the review, improvement of processes, education, troubleshooting and recommend prioritization of issues.
Provides and creates education as neededMonitors QA results to assist Coding Leadership in root cause analysis and educational opportunities
Assists with curriculum development
Assists in ensuring coding staff adherence with coding guidelines and policy
Demonstrates and applies expert level knowledge of medical coding practices and concepts
Participates on special reviews or projects
Maintains or exceeds 95% productivity standards
Maintains or exceeds 95% accuracy
Meets all educational requirements as stated in current Company policy
Reviews all official data quality standards, coding guidelines, Company policies and procedures, and clinical/medical resources to assure coding knowledge and skills remain currentPerforms an annual education needs assessment as input to the strategic coding education program and provides this assessment to the Coding Leadership team
Communicates Coding topics and/or question trends to Coding Leadership for global education
Coaches and mentors coding staff as they develop and grow their coding skills
Provides skilled coding support through regularly scheduled coding meetings and as the need arises
Researches external sources for common coding trends and questions
Works on special projects as assigned
Applies adult learning concepts when developing, delivering or assisting others for educational programs
Provides high level of customer service
Practices and demonstrates adherence to the Companys Code of Conduct and ethics philosophy and Companys Mission and Values
Completes other duties as assigned
Performs other duties as assigned
Education: High School graduate or GED equivalent required, undergraduate (associates or bachelors) degree in HIM/HIT preferred.
Experience: Proven work experience in areas of coding education strongly preferred. Minimum of 5 years acute care inpatient/outpatient coding experience required. Minimum of 3 years coding auditing/monitoring experience strongly preferred.
Licensure/Certifications/Registrations Required: RHIA, RHIT, CCS, or CPC required
Knowledge, Skills and Abilities:
Coding Technical/Professional Knowledge and Skills- extensive regulatory coding, (ICD-10-CM, ICD-10- PCS, CPT-4, Modifiers, MS-DRGs, POA assignment and where applicable APR-DRGs and APCs) and associated reimbursement knowledge
Effective Decision Making - relating and comparing; securing relevant information and identifying key issues; committing to an action after developing alternative courses of action that take into consideration resources, constraints, and organizational values
Adaptability to major changes in work responsibilities or environment; adjusting effectively to work within new work structures, processes, requirements, or cultures
Initiative - independently takes prompt proactive steps toward problem resolution
Contributing to Team Success by actively participating as a member of the team to move the teamtoward the completion of goals
Work Standards setting high standards of performance for self and others; assuming responsibility and accountability for successfully completing assignments or tasks; self- imposing standards of excellence rather than having standards imposedCommunication - communicates clearly and concisely, verbally and in writing.
Customer Orientation - establishes and maintains long-term customer relationships, building trust and respect by consistently meeting and exceeding expectations.
Interpersonal Skills - able to work effectively with other employees, patients and external parties.
Data Analysis able to analyze, interpret and share data in a presentation format.
Knowledge of Healthcare Information - familiar with various types and sources of health care information, including financial and patient level data files.
Work Independently, with experience working in a team environment.
PC Skills - demonstrates proficiency in Microsoft Office applications and others as required.
Policies & Procedures - demonstrates knowledge and understanding of organizational policies, procedures, systems and query handbook.
OU Medicine has a comprehensive benefits package, including PTO, 401(k), medical and dental plans, but our offerings go beyond traditional packages. We know that a total benefits and compensation package, designed to meet your specific needs and goals both inside and outside of the work environment, brings additional rewards that create peace of mind for you and your family.
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