CODER EDUCATOR-LGH HIM-FULL TIME (JOB ID: 2451)
Location: 900 BUILDING
Employment Status: FT
SUMMARY: The Coding Educator will coordinate outpatient coding audits and education functions. This individual will be responsible for managing and working the coding edits and denials for outpatient coding and will provide coding feedback for education opportunities identified to the coding team. Prepares and presents educational programs related to coding. Must be familiar with reviewing documentation to assign appropriate CPT/HCPCS and ICD-10-CM-PCS diagnosis codes, understand current professional coder workflows, reviews principal, secondary diagnoses and procedures for hospital services for Outpatient records based on knowledge of coding systems, including ICD-10 and CPT.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
· Onboarding, training and auditing of new hires.
· Monitors and reports the coder’s progress through the orientation and training processes.
· Establishes timelines for training completion specific to level of training necessary.
· Actively assigns Healthstream courses to new and existing employees.
· Runs completion reports from Healthstream and presents data to Coding Manager.
· Provides quarterly/monthly education to coders regarding changes, deletions and additions to ICD-10-CM/PCS and
· Provides quarterly education to outpatient coders regarding Coding Clinic Updates.
· Assists in training of ULL students regarding outpatient coding.
· Reviews cases for accurate coding, monitoring the assignment and sequencing of ICD-10-CM/PCS and CPT codes to facilitate the correct assignment of diagnostic and procedure codes.
· Works as subject matter expert and provides expertise when applicable.
· Performs and reports research on topics related to health information management, coding, billing and related compliance issues.
· Ensures audit findings and trends are investigated and education is prepared and reviewed with coding staff when necessary
· Works coding edits and denials and provides feedback and coding education to coding staff regarding completeness and accuracy of code assignment.
· Utilizes retrospective information to address possible coding and/or documentation issues related to submitted diagnosis and procedure information obtain from the health record.
· Performs reviews in a timely manner to maintain DNFB within the assigned targeted goals.
· Develops and provides ICD-10-CM, CPT/HCPCS, APC auditing and coding education to outpatient coders on a monthly basis.
· Assist system coding leadership with training and/or development of a performance improvement track for coding staff in the disciplinary process related to quality or productivity performance.
· Keeps abreast of new regulatory requirements, annual revisions to the codes, and applies this information appropriately.
· Monitors changes in laws regulations, standards as they that affect coding, billing and related compliance.
· Reads, analyzes and interprets laws, regulations, policies and procedures governing the healthcare revenue cycle.
· Identifies potential areas of compliance vulnerability and risk, develops and identifies potential corrective action plans for resolution of problematic issues, and provides general guidance on how to avoid or deal with similar situations in the future.
· Performs special coding related projects as assigned.
· Accurately codes and sequences all diseases and procedures found in the medical record using ICD-10 and CPT-4 coding systems.
· Keeps current with ongoing coding changes.
· Assigns appropriate APGs to insurance claims.
· Abstracts information from the medical record for statistical purposes.
· Consistently monitors patient records with a pending diagnosis.
· Regularly works on the Accounts Pending List
· Sequences diagnoses and procedures accurately according to coding principles
· Knowledge as it relates to, but not limited to, electronic health record, health information systems and healthcare applications and their effects on Coding practices today and in the future.
· Knowledge of ICD-10-CM, ICD-10-PCS, CPT/HCPCS, APR-DRG and APC coding principles and guidelines.
· Experience in ICD-10-CM/PCS, auditing, coding and reimbursement training.
· Knowledge of Outpatient Prospective Payment System (OPPS) methodology for outpatient.
· Extensive knowledge of hospital coding
· Knowledge of documentation regulations of Joint Commission and CMS.
· Knowledge of medical terminology, classifications systems and vocabularies.
· Knowledge of privacy and security regulations, confidentiality, laws, access and release of information practices.
· Experience in assisting and identifying learning needs as well as providing education and training designed to support a learning organization.
· Strong analytical abilities and problem-solving skills.
· Excellent oral, written and interpersonal communication skills.
· Ability to organize and set priorities to ensure objectives are met in a timely manner.
· Ability to adapt to change and handle challenges proactively and with pose.
· Ability to effectively collaborate with physicians and managerial staff at all levels.
· High ethical standards.
· Associates or Bachelor’s degree in Health Information Management required.
· One (1) year outpatient hospital coding experience with advanced knowledge of CPT-4 Coding Guidelines, Coding Clinic, APC reimbursement and extensive knowledge of complex disease processes
· RHIA/ RHIT required.
3M Coding and Reimbursement System
PHYSICAL DEMANDS AND WORKING CONDITIONS:
Sitting, standing, and light lifting. Corrected vision and hearing to within normal range. Works inside with adequate lighting, comfortable temperature and ventilation.
Formal application; verification of education, and experience; verification of license(s), certification(s), registration(s), accreditation(s) if applicable; oral interview, reference and background checks; job related tests may be required.
The duties listed above are intended only as illustrations of the various types of work that may be performed. The omission of specific statements of duties does not exclude them from the position. The job description does not constitute an employment agreement between the Hospital/Clinic and the employee. The job description is subject to change as the needs of the Hospital/Clinic and requirements of the job change.
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skills, and abilities required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Must comply with all SERVICE Standards of Behavior