Ensures accurate and appropriate coding and documentation of clinicians through coaching, training and monitoring. Provides documentation training and coaching for clinicians. Monitors training success through encounter audits and assures corrective actions are implemented. Serves as the local expert on Official Coding and Documentation Guidelines and other internal and external regulatory requirements (e.g., Centers for Medicare &Medicaid Service (CMS), National Committee for Quality
Assurance (NCQA).
Essential Functions:
- Delivers coding and documentation training in multiple ways including individual clinician, groups of clinician and departmental meetings.
- Serves as the local expert to Medical Center leadership and Coding and Documentation team on internal and external regulatory requirements (e.g., CMS, NCQA).
- Works with local Coding and Documentation team to address operational processes that hinder encounter data capture.
- If impact extends beyond the medical center, work with EIO to assure regional resolution.
- Actively participates with local Coding and Documentation team to ensure local objectives are met and regional CMS compliance activities are supported.
- Participates in various local committees, e.g. CDI, ROG, PCM, etc.
- Acts as communication link regarding changes to federal and state government billing and coding
guidelines.
- Works with medical center leadership to provide confidential audits and feedback on an 'as needed' basis.
- Support the preparation and performance of medical center auditing analysis.
- Collects data and performs analysis to determine root causes of under or over reporting as well as quantifying the effect of the condition identified in the audit.
- Recommends appropriate actions.
- Partners with the local Data Quality Auditor and the EIO Training and Audit Managers to identify audit trends and risk areas based on audit findings and data analysis.
- Conducts both Medicare and E/M audits on an as-needed basis.
- Assures corrective actions are implemented for audit review findings.
- Mentors and coaches Data Quality Auditor.
- Assists in developing and implementing policies and procedures, compliance audit standards to ensure compliance with Federal, State and other regulatory requirements and assures local compliance with these policies and procedures.
- Accountable for consistently demonstrating the knowledge, skills, abilities, and behaviors necessary to
provide superior and culturally sensitive service to each other, to our members, and to purchasers,
contracted providers and vendors.
- NOTE: Travel between Medical Center facilities may be required.
Secondary Functions:
- Supervises Data Quality Auditors, overseeing the monitoring of training and coaching success in Outpatient Clinic and Emergency departments through encounter audits and assuring corrective actions are implemented.
- Serves as the local expert on the Official ICD-9-CM Documentation Guidelines and other internal and external regulatory requirements (e.g., Centers for Medicare & Medicaid Service (CMS), National Committee for Quality Assurance (NCQA)).
-In collaboration with the Encounter Information Operations (EIO) Training Manager and the local Data Quality Auditor, maintains a training program that supports documentation improvement and addresses documentation risk areas identified through local and regional audits. Training will be delivered in multiple ways including individual clinician, groups of clinician and departmental meetings.
- Assures the planning, scheduling and performance of concurrent and retrospective encounter audits, in accordance with regional compliance plan.
- 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.
- Work with local CMS team and OSCR Liaison / Coordinator to address operational processes that hinder encounter data capture. If impact extends beyond the medical center, work with EIO to assure regional resolution. Assures that audit results are entered into regional audit database to support quality assurance process, regional analysis and regional training activities.
- Oversees the preparation and/or performance of medical center auditing analysis and/or special projects.
Qualifications:
Basic Qualifications:
- Significant (five (5) plus years or more) of experience with coding based on Coding Clinic Guidelines for inpatient and outpatient.
- Three (3) plus years of experience developing and conducting training/educational sessions for diverse audiences with minimal supervision.
- Significant experience in performing both E/M and Medicare audits.
- Demonstrated experience conducting Medical Record audits including analysis and the creation/implementation of action plans that address audit finding.
- Bachelor's degree (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).
- Ability to work with and maintain confidentiality of physicians, patients, patient accounts and personnel data.
- Strong interpersonal and excellent written, verbal and presentation skills.
- Willingness to be flexible depending upon department and/or physician schedule needs.
- Demonstrated ability to develop data requirements and work with analytical groups to extract, organize and analyze data to identify trends, risk areas, and recommend appropriate actions.
- Must be able to work in a Labor / Management Partnership environment.
Preferred Qualifications:
- Experience using PC applications such as MS Word, Excel, Access, PowerPoint preferred.
- Medical center operations or clinical experience preferred.
- Demonstrated project management experience including design and implementation of audit plans.
-Supervisory experience (2 or more years).
- Demonstrated ability to work within a team environment and build effective teams.
- Demonstrated ability to review analytical data and audit findings to identify documentation trends and other risk areas.
External hires must pass a background check/drug screen.
We are proud to be an equal opportunity/affirmative action employer.