Under minimal supervision, ensures accurate and appropriate documentation through local coaching and monitoring. Provides documentation coaching to clinicians in the Outpatient Clinic and Emergency Department. Monitors success of coaching and training efforts through encounter audits which ensure documentation meets requirements for diagnosis and E&M assignment, based on Official ICD-9-CM Documentation Guidelines.
Essential Functions:
- Using independent judgment and sensitivity, coaches individual physicians, reviewing their audit findings, making suggestions for documentation improvements and updating on changes to Federal and State government billing and coding guidelines.
- Partners with Trainer in the development of future training that will address documentation risk areas identified through local and regional audits.
- Plans, schedules and performs encounter audits to monitor performance and ensure lasting improvement.
- Encounter audits will be the primary monitoring tool used to identify operational and regulatory issues related to coding, documentation, and compliance requirements and to ensure complete and accurate data capture in compliance with Federal and State requirements.
- Monitors corrective actions for audit review findings.
- Serves as a local resource in meeting internal and external regulatory requirements (e.g., Centers for Medicare & Medicaid Service (CMS), National Committee for Quality Assurance (NCQA)).
- Actively participates with local CMS (Center for Medicare/Medical Services) team to ensure local objectives are met and regional CMS compliance activities are supported.
- Works with medical center leadership to provide confidential audits and feedback on an 'as needed' basis.
- Assists in the identification of operational processes that hinder encounter data capture.
- Enters encounter audit results into regional audit database to support quality assurance process, regional analysis and regional training activities.
- Prepares and/or performs medical center auditing analysis and/or special projects as assigned.
- Partners with Data Quality Trainer and other local analytical workgroups to identify audit trends and risk areas based on audit findings and data analysis.
- Assists in developing and implementing policies and procedures / Compliance Audit Standards to ensure compliance with Federal, State and other regulatory requirements.
- NOTE: Travel between Medical Center facilities may be required.
Qualifications:
Basic Qualifications:
- Significant experience coding, three (3) or more years, based on Coding Clinical Guidelines for inpatient and outpatient.
- Demonstrated experience conducting Medical Record audits and ability to interpret and apply Federal and State regulations, coding and billing requirements.
- Demonstrated project management experience including design and implementation of audit plans.
- Experience using PC applications such as MS Word, Excel, Access, PowerPoint, preferred.
- Medical center operations or clinical experience, preferred.
- Bachelor's degree in business administration, health care, public health, finance, business medical records technology OR equivalent experience.
- Certification in one of the following: Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Coding Specialist (CCS), Certified Professional Coder (CPC).
- Demonstrated ability to constructively and sensitively provide feedback to providers and medical center leadership regarding federal and state coding, medical documentation and compliance guidelines, audit results and risk areas.
- Ability to work with and maintain confidentiality of physician, patient, patient account and personnel data.
- Strong interpersonal and excellent written, verbal and presentation skills.
- Demonstrated ability to work independently with minimal supervision.
- Demonstrated ability to work within a team environment.
- Willingness to be flexible depending upon department and/or physician schedule needs.
- Demonstrated ability to review analytical data and audit findings to identify documentation trends and other risk areas.
- Demonstrated ability to develop data requirements and work with analytical groups to extract, organize and analyze coded data.
- Must be able to work in a Labor/Management Partnership environment.
Preferred Qualifications:
-Ability todemonstrate coding knowledge with ICD-9-CM), CPT HCPCS.
External hires must pass a background check/drug screen.
We are proud to be an equal opportunity/affirmative action employer.