CODING SPEC-CLINIC

Position Summary

This individual provides leadership, direction, and training for the coding staff. Working directly with the physicians, Manager of Corporate Coding Services, Director of Registration/Admitting, and medical staff education efforts, serves as the user advocate between Health Information Management (HIM), Clinical Effectiveness, and Registration. Other job duties include: improving health record documentation and coding accuracy, developing and updating all departmental policies and procedures relative to coding, performing quality reviews of coding/abstracting, and focusing on problem solving issues related to denials.

Provides assurance that billing practices are complete, accurate, and in compliance with state and federal guidelines.

Responsibilities

• Oversees through monitoring and by reviewing and auditing the coding staff to ensure position accountabilities and performance criteria are adhered to.
• Develops and maintains departmental and hospital policies and procedures and implements new policies and procedures relative to coding.
• Educates and assists physicians and clarifies coding versus clinical issues.
• Works closely with Registration and Business Office personnel to resolve issues related to claims, coding, pre-cert, and denials appeals, and verifies that appropriate chargemaster rates are used.
• Reviews medical record documentation to ensure existing documentation supports diagnostic/procedure code billed per UB 92 or HCFA 1500 form.
• Provides education to coding staff and physicians in response to regulatory changes and identified areas of deficiency.
• Makes sure claim rejections are reviewed and systematic assessment of specific types of denials as it relates to coding and documentation issues, outpatient registration, and the receipt of physician orders.
• Attends meetings and provides input as it relates to coding, medical documentation, and reimbursement issues specific to medical billing and regulatory requirements.
• Increases awareness of compliance as it relates to coding and documentation.
• Facilitates and coordinates education of coding staff in the areas of coding, documentation, case mix, and denials.
• Increases understanding of APCs, DRGs, case mix, and denials.
• Edits coding staff to proper documentation necessary to support a DRG/APC/Medical Necessity/ROM/SOI.
• Integrates documentation, coding, and proper oversight to ensure accurate reimbursement.
• Reviews records to verify if the correct code has been assigned.
• Assists with all insurance requested audits and provides information to supervisor related to inaccurate and/or missing documentation.
• Reviews DRG/APC classifications and educates to maximize level of care assignment for increased reimbursement.
• Keeps current on local, state, and federal regulations to ensure compliance.
• Keeps current on coding guidelines and communicates to Health Information Manager.
• Implements corrective actions as indicated to minimize financial risk.
• Works with Denials Elimination Group and deals with physician specific issues as it impacts denials.
• Ensures LCDs/NCDs are being adhered to by admissions and hospital personnel to ensure qualifying diagnosis covers tests/procedures.
• Analyzes denials and coordinates appeals.
• Ensures corrective action is taken to prevent denials from reoccurring.

Qualifications

• Minimum Education: None specified; however, must be sufficient to meet the standards for achievement of the below indicated license and/or certification as required by the issuing authority.
• Minimum Experience: Five or more (5+) years coding experience.
• Licensure Requirement: RHIA, Coding, or RHIT certification required. Registered Health Information Technologist preferred.