Credentialed Inpatient Auditor (Coding Quality Review / Educator) WFH (OK, TX, A
OU Health, Little Rock, AR, United States
Position Title: Credentialed Inpatient Auditor (Coding Quality Review / Educator) WFH (OK, TX, AR, KS, MO)
Department: HIM Coders
Remote Eligibility
Candidates must reside and work full-time in AR, KS, MO, OK, or TX before their first day of employment.
Ideal candidate will have experience in academic medical center complex inpatient coding.
General Description
Performs internal quality assessment reviews on OUH coders to ensure compliance with national coding guidelines and the OUH coding policies for complete, accurate and consistent coding which result in appropriate reimbursement and data integrity. Helps to coordinate and direct the day-to-day coding educational activities. Facilitates and provides coding educational classes/presentations to staff, as required/when needed. Communicates outcomes to the coding team to improve the accuracy, integrity and quality of patient data, to ensure minimal variation in coding practices and to improve the quality of physician documentation within the body of the medical record to support code assignments. Responsibilities also include assisting Coding Leadership in root cause analysis of coding quality issues, performing account reviews, and preparing training documents to assist with coding quality action plans.
Essential Responsibilities
Responds to coding-related questions from HSC coding staff
Leads, coordinates and performs all functions of quality reviews (routine, pre-bill, policy driven and incentive plan driven) for inpatient coding across OUMS
Provides Coding Integrity Specialist (CIS) and CQR education as needed
Initiates the rebilling process as required per policy on special projects
Researches coding opportunities and escalates as needed
Assists in the review, improvement of processes, education, troubleshooting and recommend prioritization of issues.
Provides and creates education as needed
Monitors QA results to assist Coding Leadership in root cause analysis and educational opportunities
Assists with curriculum development
Assists in ensuring coding staff adherence with coding guidelines and policy
Demonstrates and applies expert level knowledge of medical coding practices and concepts
Participates on special reviews or projects
Maintains or exceeds 95% productivity standards
Maintains or exceeds 95% accuracy
Meets all educational requirements as stated in current Company policy
Reviews all official data quality standards, coding guidelines, Company policies and procedures, and clinical/medical resources to assure coding knowledge and skills remain current
Performs an annual education needs assessment as input to the strategic coding education program and provides this assessment to the Coding Leadership team
Communicates Coding topics and/or question trends to Coding Leadership for global education
Coaches and mentors coding staff as they develop and grow their coding skills
Provides skilled coding support through regularly scheduled coding meetings and as the need arises
Researches external sources for common coding trends and questions
Works on special projects as assigned
Applies adult learning concepts when developing, delivering or assisting others for educational programs
Provides high level of customer service
Practices and demonstrates adherence to the Company's Code of Conduct and ethics philosophy and Company's Mission and Values
Completes other duties as assigned
General Responsibilities
Performs other duties as assigned
Minimum Qualifications
Education:
High school diploma or GED required. Associate's or Bachelor's degree in HIM/HIT preferred.
Experience:
Minimum of five (5) years acute care inpatient coding experience required. Three (3) years inpatient coding auditing experience strongly preferred.
License(s)/Certification(s)/Registration(s) Required:
RHIA, RHIT, CCS, or CPC required.
Knowledge, Skills and Abilities
Coding Technical/Professional Knowledge and Skills:
extensive regulatory coding (ICD-10-CM, ICD-10-PCS, CPT-4, Modifiers, MS-DRGs, POA assignment and where applicable APR-DRGs and APCs) and associated reimbursement knowledge
Effective Decision Making:
relating and comparing; securing relevant information and identifying key issues; committing to an action after developing alternative courses of action that take into consideration resources, constraints, and organizational values
Adaptability:
to major changes in work responsibilities or environment; adjusting effectively to work within new work structures, processes, requirements, or cultures
Initiative:
independently takes prompt proactive steps toward problem resolution
Contributing to Team Success:
by actively participating as a member of the team to move the team toward the completion of goals
Work Standards:
setting high standards of performance for self and others; assuming responsibility and accountability for successfully completing assignments or tasks; self-imposing standards of excellence rather than having standards imposed
Communication:
communicates clearly and concisely, verbally and in writing.
Customer Orientation:
establishes and maintains long-term customer relationships, building trust and respect by consistently meeting and exceeding expectations.
Interpersonal Skills:
able to work effectively with other employees, patients and external parties.
Data Analysis:
able to analyze, interpret and share data in a presentation format.
Knowledge of Healthcare Information:
familiar with various types and sources of health care information, including financial and patient level data files.
Work Independently:
with experience working in a team environment.
PC Skills:
demonstrates proficiency in Microsoft Office applications and others as required.
Policies & Procedures:
demonstrates knowledge and understanding of organizational policies, procedures, systems and query handbook.
OU Health is an equal opportunity employer. We offer a comprehensive benefits package, including PTO, 401(k), medical and dental plans, and many more.
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Department: HIM Coders
Remote Eligibility
Candidates must reside and work full-time in AR, KS, MO, OK, or TX before their first day of employment.
Ideal candidate will have experience in academic medical center complex inpatient coding.
General Description
Performs internal quality assessment reviews on OUH coders to ensure compliance with national coding guidelines and the OUH coding policies for complete, accurate and consistent coding which result in appropriate reimbursement and data integrity. Helps to coordinate and direct the day-to-day coding educational activities. Facilitates and provides coding educational classes/presentations to staff, as required/when needed. Communicates outcomes to the coding team to improve the accuracy, integrity and quality of patient data, to ensure minimal variation in coding practices and to improve the quality of physician documentation within the body of the medical record to support code assignments. Responsibilities also include assisting Coding Leadership in root cause analysis of coding quality issues, performing account reviews, and preparing training documents to assist with coding quality action plans.
Essential Responsibilities
Responds to coding-related questions from HSC coding staff
Leads, coordinates and performs all functions of quality reviews (routine, pre-bill, policy driven and incentive plan driven) for inpatient coding across OUMS
Provides Coding Integrity Specialist (CIS) and CQR education as needed
Initiates the rebilling process as required per policy on special projects
Researches coding opportunities and escalates as needed
Assists in the review, improvement of processes, education, troubleshooting and recommend prioritization of issues.
Provides and creates education as needed
Monitors QA results to assist Coding Leadership in root cause analysis and educational opportunities
Assists with curriculum development
Assists in ensuring coding staff adherence with coding guidelines and policy
Demonstrates and applies expert level knowledge of medical coding practices and concepts
Participates on special reviews or projects
Maintains or exceeds 95% productivity standards
Maintains or exceeds 95% accuracy
Meets all educational requirements as stated in current Company policy
Reviews all official data quality standards, coding guidelines, Company policies and procedures, and clinical/medical resources to assure coding knowledge and skills remain current
Performs an annual education needs assessment as input to the strategic coding education program and provides this assessment to the Coding Leadership team
Communicates Coding topics and/or question trends to Coding Leadership for global education
Coaches and mentors coding staff as they develop and grow their coding skills
Provides skilled coding support through regularly scheduled coding meetings and as the need arises
Researches external sources for common coding trends and questions
Works on special projects as assigned
Applies adult learning concepts when developing, delivering or assisting others for educational programs
Provides high level of customer service
Practices and demonstrates adherence to the Company's Code of Conduct and ethics philosophy and Company's Mission and Values
Completes other duties as assigned
General Responsibilities
Performs other duties as assigned
Minimum Qualifications
Education:
High school diploma or GED required. Associate's or Bachelor's degree in HIM/HIT preferred.
Experience:
Minimum of five (5) years acute care inpatient coding experience required. Three (3) years inpatient coding auditing experience strongly preferred.
License(s)/Certification(s)/Registration(s) Required:
RHIA, RHIT, CCS, or CPC required.
Knowledge, Skills and Abilities
Coding Technical/Professional Knowledge and Skills:
extensive regulatory coding (ICD-10-CM, ICD-10-PCS, CPT-4, Modifiers, MS-DRGs, POA assignment and where applicable APR-DRGs and APCs) and associated reimbursement knowledge
Effective Decision Making:
relating and comparing; securing relevant information and identifying key issues; committing to an action after developing alternative courses of action that take into consideration resources, constraints, and organizational values
Adaptability:
to major changes in work responsibilities or environment; adjusting effectively to work within new work structures, processes, requirements, or cultures
Initiative:
independently takes prompt proactive steps toward problem resolution
Contributing to Team Success:
by actively participating as a member of the team to move the team toward the completion of goals
Work Standards:
setting high standards of performance for self and others; assuming responsibility and accountability for successfully completing assignments or tasks; self-imposing standards of excellence rather than having standards imposed
Communication:
communicates clearly and concisely, verbally and in writing.
Customer Orientation:
establishes and maintains long-term customer relationships, building trust and respect by consistently meeting and exceeding expectations.
Interpersonal Skills:
able to work effectively with other employees, patients and external parties.
Data Analysis:
able to analyze, interpret and share data in a presentation format.
Knowledge of Healthcare Information:
familiar with various types and sources of health care information, including financial and patient level data files.
Work Independently:
with experience working in a team environment.
PC Skills:
demonstrates proficiency in Microsoft Office applications and others as required.
Policies & Procedures:
demonstrates knowledge and understanding of organizational policies, procedures, systems and query handbook.
OU Health is an equal opportunity employer. We offer a comprehensive benefits package, including PTO, 401(k), medical and dental plans, and many more.
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