Duties and Responsibilities of this Level:

A. Monitor data quality and optimal reimbursement to the hospital by performing concurrent and prospective quality reviews for the accurate coding and sequencing of ICD-10-CM diagnoses and ICD-10-PCS or rCPT-4 procedures (and appropriate use of modifiers) for inpatient and outpatient services using Center for Medicare and Medicaid coding guidelines, standards and regulations.

35% of the time spent

• Interpret guidelines, applicable laws, and regulations concerning hospital coding published in AHA Coding Clinic, AMA CPT Assistant, the Federal Register, Medicare Bulletin, etc. Develop and maintain specific coding guidelines for inpatient and outpatient care.Research problem areas and develop training materials and coding aids for the coders.
• Present timely, relevant education programs to coding staff regarding coding updates, documentation, and prospective payment system requirements. Participate in the training of the coders and evaluate the effectiveness of the training.
• Maintain or update the coding compliance manual.
• Monthly report on findings to coding staff and others (including the Compliance Department).

B. Identify coding and billing risk areas for the hospital technical ch charts, conduct focused reviews, report results, and implement corrective action as needed30% of time spent

• Serves as the technical expectation for questions
• Report the results and recommend corrective action as needed. Conduct routine internal audits of coded data and physician documentation.
• Respond promptly to external audits and implement corrective action as appropriate.

C. Serve as a resource to the hospital on coding and documentation-related issues. Educate physicians and other healthcare professionals regarding documentation requirements for accurate coding and reimbursement. Educate administration, financial management, revenue managers, etc. regarding DRGs, APCs, and APR-DRGs and the reimbursement methodologies.

30% of time spent

• Collaborates with HB Coding, Billing, and others for process or system changes.
• Participates in the creation and execution of educational initiatives associated with HIM strategies.
• Effectively communicates verbally and in written form, including provision of updates to the Associate Director and Director regarding the operation of the work unit, project status, and staff issues

D. Other: 5% of time spent

performs other related duties incidental to the work described herein and performs other related work as required