Job Description
Job Summary This position oversees and directs the team responsible for ensuring correct coding across the system. This position is primarily responsible for coding quality improvement and staff education. Ensures the accuracy of coding assignments using random auditing methodology. Responsible for responding to requests from the Central Business Office regarding medical record investigation for outpatient/inpatient billing due to claims holding for the National Correct Coding Initiative (NCCI), Outpatient Code Editor (OCE), or any other payor edits. This position also communicates coding processes and program status regularly through mass communications to physicians, clinical operations staff, and leadership. Job Duties Provides direction and management to the Professional Coding Operations Department. Responsible for the integrity, quality, accuracy and performance of the coding program. Responds to requests from billing office for claims holding in billing system as a result of payor edits or rejections. Reviews account detail and compare to the medical records for accurate selection of diagnoses and procedure codes as a quality measure for all coding activity. Reviews Local Medical Review Policies and other third party payor documents to ensure codes meet the payor billing requirements. Provides consultative support to clinical areas on a daily basis for correct code reporting related to revenue enhancement. Accesses patient charge detail on the patient financial system to work toward the process of reconciliation of documentation from the medical record to the final bill to ensure compliance. Acts as a liaison with physicians to ascertain and correct information needed to resolve discrepancies regarding diagnoses and procedures based on standard clinical pathways and translation of clinical data into coded form. Provides suggestions and supporting information to improve the error rate related to diagnoses and procedure edits. Researches coding compliance, keeps up-to-date on areas of focus by the OIG, HCFA, PRS and other payors and review organizations Develops in concert with Coding Program Trainer materials for coding staff and physicians on documentation and coding issues. Conducts and documents training sessions related to Coding updates. Directs the above-mentioned activities of the revenue cycle to ensure cost effectiveness and organizational efficiency. Furthermore, this position provides direction to these functions and how the functions in question inter-relate to the other revenue cycle functions including Patient Access, Medical Records, Professional Billing and Collections, Hospital Collections, Revenue Enhancement, Human Resources, Information Systems, Financial Reporting, Process Improvement, Charge Entry, Training, Corporate Finance, MyVisit, and Customer Service. Develops implements and directs various quality initiatives to ensure continuous monitoring and improvements within the revenue cycle process of Geisinger. This includes managing an overall departmental operating and capital budget(s) within pre-determined limits and within Freedom-To-Act guidelines to insure operational efficiencies and obtaining pre-determined performance targets. Facilitates various technological initiatives in support of coding and business process improvements with respect to hospital and professional coding management operations. Assists with the establishment of training tools for all revenue cycle employees in regards to hospital and professional financial business strategies and communicate ongoing improvements relative to process improvement and employee development. Work is typically performed in an office environment. Accountable for satisfying all job specific obligations and complying with all organization policies and procedures. The specific statements in this profile are not intended to be all-inclusive. They represent typical elements considered necessary to successfully perform the job. Position Details One relevant certification from AHIMA or AAPC is required upon hire. Acceptable certifications include: AHIMA (American Health Information Management Association) Certified Coding Specialist (CCS) Certified Coding Specialist – Physician-based (CCS-P) Registered Health Information Technician (RHIT) Registered Health Information Administrator (RHIA) Certified Coding Associate (CCA) – Candidates with only a CCA are required to obtain a CCS, RHIT, or RHIA within 12 months of hire. All certifications are acceptable from AAPC (American Academy of Professional Coders) except: Scribe, Documentation, Instructor, and International Credentials Certified Professional Biller (CPB) Reven