Coding Quality & Edu Spec​/HIM Coding

Position: Coding Quality & Edu Spec 1 / HIM Coding

Coding Quality & Edu Spec 1 / HIM Coding

Location: Curtis-181 Patricia Genova Dr (10016)

Shift: 1st Shift

Job Summary and Responsibilities

• Validates ICD-10-CM diagnoses and ICD-10-PCS or CPT codes and resulting DRGs/APCs to ensure consistency and efficiency in claims processing, data collection, and quality reporting for HHC.
• Validates Home Health Coding/OASIS reviews.
• Prepares written reports on the results of the audits, including recommendations for improvement and compliance with state and federal laws, regulations and policy.
• presents audit reports, results and action plans to coding management for discussion and plan for dissemination to coders.
• presents quarterly Key Performance Indicators (KPI) to compliance office.
• Responsible for managing CHIME (Connecticut Health Information and Management Exchange) and Premier system edits.
• Utilize Cobius Institutional Audit Manager (IAM) software to streamline audits, communicate findings and simplify reports.

Education/Training

• Provides feedback and creates focused educational/training programs on the results of auditing and monitoring activities for coders, CDS and providers as appropriate.
• Provides Coder, CDS staff and provider education on changes in regulations related to coding.
• Provides coding feedback on complex cases.

Communication

• Ensures the appropriate dissemination and communication of all regulation, policy, and guideline changes (e.g., Code updates, coding guidelines, Local Coverage Determinations (LCD), Transmittals) to affected personnel.
• Maintains system folders with coding policies, procedures, educational articles and coding compliance materials.

Other

• Participates in the development and review of HIM Coding Policy and Procedures.
• Participates in general or special assignments and other duties as assigned.
• Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association and adheres to official coding guidelines.

Qualifications Education

Associates Degree or equivalent experience.

Experience

• Four or more years of progressive on-the-job coding experience in an acute care hospital.

Licensure, Certification, Registration

• CCS or CPC certification.
• For Home Health Hospice:
  Home Health Coding Specialist – Diagnosis (HCS-D) and/or Home Care Coding Specialist – Hospice (HCS-H).
• Home Health Clinical Specialist - OASIS (HCS-O) or OASIS Specialist – Certified (COS-C).

Language Skills

• Strong written and verbal communication skills.
• Solid analytical capabilities.
• Good organizational skills.
• Critical thinking, problem solving and deductive reasoning skills.

Knowledge, Skills and Ability Requirements

• Comprehensive understanding of ICD-10-CM diagnosis and ICD-10-PCS and/or CPT/HCPCS operative procedure codes.
• Understands the Uniform Hospital Discharge Data Set (UHDDS).
• Understands MS-DRGs, APCs and/or Outpatient Code Edits (OCE) and Correct Coding Initiative (CCI) edits.
• IRF-PAI (IP Rehabilitation).
• Home Health understands:
  • PDGM payment model.
  • OASIS.
• Working knowledge of clinical information.
• Extensive knowledge of state, federal and Medicare regulations related to coding.
• Basic knowledge of the revenue cycle for the purpose of communicating corrective action recommendations.
• Microsoft Office Products;
  Word, Excel.
• Encoder and/or Computer Assistant Coding (CAC).
• HROI and Cobius.

Ability To

• Function independently.
• Handle multiple priorities.
• Listen and acknowledge ideas and expressions of others attentively.
• Converses clearly using appropriate verbal and body language.
• Collaborate with others to achieve a common goal through mutual cooperation.
• Influence others for positive and productive outcomes.

We take great care of careers. With locations around the state, Hartford Health Care offers exciting opportunities for career development and growth. Here, you are part of an organization on the cutting edge – helping to bring new technologies, breakthrough treatments, and community education to countless men, women, and children. We know that a thriving organization starts with thriving employees– we provide a competitive benefits program designed to ensure work/life balance.

Every moment matters. And this is your moment.

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