Coding Quality Review Spec
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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.
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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.
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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.
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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.
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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.
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PHYSICAL DEMANDS
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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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