Job Location |
Geographic Location: Honolulu, Hawaii 96844
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| Coordinator/Educator, Coding Quality |
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Job Code: 428
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A. Performs regular coding quality reviews and coordinates ongoing monitoring of coding accuracy and documentation adequacy on inpatient and outpatient records to validate the ICD-9-CM and CPT codes, DRG/APC group appropriateness, missed secondary diagnoses and procedures as well as compliance with all CMS mandates and reporting requirements. Monitors Medicare and other payer bulletins and manuals and reviews the current OIG Work plans for risk areas.
B. Continuously evaluates the quality of clinical documentation to spot incomplete or inconsistent documentation that impact the code selection and resulting DRG/APC groups and payment. Brings identified concerns to department managers and physicians for resolution.
C. Develops and coordinates educational and training programs for facility healthcare professionals related to coding guidelines and practices, proper documentation techniques, and disease processes as it relates to the DRG/APC and other clinical data quality management factors.
D. Works collaboratively with Coding manager and staff, Clinical Documentation Integrity RNs, Physicians, Case Managers, Nursing and ancillary staff to improve quality of documentation and accuracy of DRG/APC assignment as well as accuracy of patients’ severity of illness and risk of mortality.
E. Performs periodic claim form reviews to check code transfer accuracy from the abstracting system and the chargemaster.
F. Reviews claim denials and rejections pertaining to coding and, when necessary, implements corrective action plan, such as educational programs, to prevent similar denials and rejections from recurring.
G. Evaluates and provides input to responses to the regulatory and insurance auditors’ change and denials notices. Provides appropriate documentation from required source to the PRO when appealing a PRO decision.
H. Attends coding and reimbursement workshops and brings back information to the appropriate departments. Communicates coding updates published in third-party payer newsletters and bulletins and provider manuals to all facility staff that need this information. Maintains knowledge of current professional coding certification requirements
I. Keeps abreast of new technology in coding and abstracting software and other forms of automation and stays informed about transaction code sets, HIPAA requirements and other future issues impacting the coding function.
J. Demonstrates competency in the use of computer applications and DRG/APC Grouper Software, Medicare edits and all coding and abstracting software and hardware currently in use by the Health Information Management department.
K. Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association.
L. Supports the philosophy and objectives of the organization and assigned department and demonstrates a commitment to overall organization success.
M. Performs duties and demonstrates behaviors appropriate to the Queen’s Health Systems’ core values of compassion, aloha, respect, and excellence and fosters superior customer service.
N. Complies with organization policies and procedures, including Corporate Compliance policies and QHS Code of Conduct, all applicable laws and regulations, and all regulatory agency requirements.
O. Protects patient/customer confidentiality and complies with HIPAA regulations.
P. Participates effectively as a team member in assigned area to achieve team goals and objectives.
Q. Establishes and maintains positive working relationships with patient and family, team members, physicians, and other staff.
R. Develops and maintains technical and other job related competencies.
S. Observes all safety and health regulations; ensures compliance with Joint Commission and accrediting agencies, as required; and, performs work in accordance with policies, procedures and standards of the organization, including attendance, punctuality, and dress standards.
T. Performs other related duties as assigned.
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Job Details |
Date Posted: 03/06/2012
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Position Type: Medical Coder
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Employment Role: Coordinator
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Career Level: Mid Level Career (5+ yrs experience)
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Minimum Education: Certification
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Travel Requirement: No Traveling
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Job Status: Full Time
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Specialty Type: Not Specified |
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Employment Setting: Hospital
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