Coding Quality Review Spec
JOB SUMMARY/PURPOSE
Responsible for providing coding and compliance expertise/services as part of an effective coding compliance program. Serves as a subject matter expert to HIM coding staff for the assigned patient types and/or service lines in outpatient and/or inpatient coding and provides coder training and educational feedback as assigned. Communicates regulatory coding and billing changes for timely and accurate implementation. Reviews and recommends response and action to DRG and/or coding validation concerns/audits from payers or their representatives. Performs coding functions as assigned.
DEPARTMENT DESCRIPTION
The Health Information Management (HIM) department manages health information systems and medical records to ensure we meet medical, legal and ethical standards. HIM staff work with Samaritan Health Services patients, staff and providers as well as numerous external entities to maintain the accuracy and completeness of the medical record; provide coded data for evaluation of services and reimbursement; and ensure authorized access to patient medical information in accordance with privacy and confidentiality requirements.
EXPERIENCE/EDUCATION/QUALIFICATIONS
High school diploma or equivalent required. Associate’s degree in a healthcare related program preferred.
Training in ICD-10-CM/PCS and CPT coding through an educational program, associate’s level coursework or equivalent education/experience required.
Current RHIA, RHIT, CCS, CPC, COC or CIC certification required.
Five (5) years of current acute care hospital coding experience in a variety of service lines required.
Experience or training in the following required:
Advanced medical terminology, anatomy and physiology, disease processes and pharmacology.
Applicable coding rules and compliance guidelines.
Computerized encoder and electronic medical record systems.
Contents of the medical record.
All candidates will be required to satisfactorily pass a coding assessment to verify minimum coding skills for this position.
KNOWLEDGE/SKILLS/ABILITIES
Knowledge of the importance of confidentiality.
Ability to organize, plan and prioritize work, as well as concentrate on a task over a period of time without being distracted.
Ability to communicate information verbally and in writing so others will understand. Ability to understand information and ideas presented verbally and in writing.
Selects and uses training/instructional methods and procedures appropriate for the situation when learning or teaching new things.
Ability to identify complex problems and review related information using logic and reasoning to develop and evaluate options and implement solutions.
Ability to monitor/assess to evaluate quality or performance of self, other individuals, products, services or processes to make improvements.
PHYSICAL DEMANDS
Rarely
(1 - 10% of the time)
Occasionally
(11 - 33% of the time)
Frequently
(34 - 66% of the time)
Continually
(67 – 100% of the time)
CLIMB - STAIRS
LIFT (Floor to Waist: 0"-36") 0 - 20 Lbs
LIFT (Knee to chest: 24"-54") 0 - 20 Lbs
LIFT (Waist to Eye: up to 54") 0 - 20 Lbs
CARRY 1-handed, 0 - 20 pounds
BEND FORWARD at waist
KNEEL (on knees)
STAND
WALK - LEVEL SURFACE
ROTATE TRUNK Standing
REACH - Upward
PUSH (0-20 pounds force)
PULL (0-20 pounds force)
SIT
CARRY 2-handed, 0 - 20 pounds
ROTATE TRUNK Sitting
REACH - Forward
MANUAL DEXTERITY Hands/wrists
FINGER DEXTERITY
PINCH Fingers
GRASP Hand/Fist
None specified
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