Job Title: Coding Quality Review Educator
Location: Oklahoma City, OK 73105
Shift: 7am – 4:30pm CST (Mon-Fri)
Duration: 6+ months (26 Weeks)
Pay rate: $35.00-40.00/hr on W2
General Description:
- Performs internal quality assessment reviews on facility's coders to ensure compliance with national coding guidelines and the facility's 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:
- Inability to perform these responsibilities with or without an accommodation may result in disqualification from the position
- 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 and outpatient coding across Facility • 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 escalate 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
- Research 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
Skills Required:
- 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.
Education Required:
- High School graduate or GED equivalent required
- Undergraduate (associates or bachelors) degree in HIM/HIT preferred
Experience Required:
- Proven work experience in areas of coding education strongly preferred
- Minimum of 5 years acute care inpatient/outpatient coding experience required
- Minimum of 3 years coding auditing/monitoring experience strongly preferred
License(s)/Certification(s)/Registration(s) Required:
- RHIA, RHIT, CCS, or CPC required
As a certified minority-owned business, Pride Global and its affiliates - including Russell Tobin, Pride Health, and Pride Now - are committed to creating a diverse environment and are proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, pregnancy, disability, age, veteran status, or other characteristics.
Pride Global offers eligible employee's comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance and hospital indemnity), a 401(k)-retirement savings, life & disability insurance, an employee assistance program, identity theft protection, legal support, auto and home insurance, pet insurance, and employee discounts with some preferred vendors.