Coding Integrity Specialist - Coding

Summary:

The CHRISTUS Health Coding Integrity Specialist is a system support position that provides acute care coding subject matter expertise, leadership, support, and direction, for the CHRISTUS Health System. The Coding Integrity Specialist will report directly to the Manager of Coding Integrity.

The Coding Integrity Specialist will demonstrate high-quality knowledge and understanding of ICD-10-CM, ICD-10-PCS, and/or CPT/HCPCS coding guidelines and practices for acute care reimbursement while maintaining a 95% audit accuracy rate. The Coding Integrity Specialist will have a strong working knowledge of CHRISTUS Health applications in addition to other applicable software, required for auditing.

The Coding Integrity Specialist is responsible for supporting adherence to CHRISTUS standards, policies, procedures, guidelines, official coding guidelines, and other regulatory requirements including Centers for Medicare and Medicaid Services (CMS), the Joint Commission, and HIPAA standards related to HIM. The Coding Integrity Specialist will be responsible for obtaining external guidance as needed from Nosology, AHA, AMA, Z Health, and other recognized sources.

The Coding Integrity Specialist will receive work assignments based on business needs, including but not limited to retrospective reviews, focused reviews, pre-bill reviews, performance improvement reviews, query quality, coding-related denials, and clinical documentation improvement opportunities. The Coding Integrity Specialist will audit for key quality metrics, including but not limited to, DRG Accuracy, POA assignment, principal and secondary diagnosis code assignment, procedural coding Accuracy, APC accuracy, modifier usage, discharge disposition, query opportunities, and abstracting accuracy.

The Coding Integrity Specialist will work collaboratively with various CHRISTUS Health teams, including but not limited to, Health Information Management, Coding Operations, Coding Managers, Coding Leads, Coders, Education, Clinical Documentation, Clinical Appeals, PFS, Corporate Compliance, Legal, Regional Leadership, and Revenue Integrity with a focus on Coding Integrity. Coding Integrity Specialists will also work collaboratively with external vendors and assist in other areas, as requested by leadership.

The Coding Integrity Specialist will complete coding audits, audit reports, statistical reports, rebuttals, and appeal correspondence in a format and venue that provides professional services and feedback. The Coding Integrity Specialist may assist with education and training for system, regional, or facility healthcare professionals on coding guidelines, practices, proper documentation techniques, medical terminology, and disease processes.

Responsibilities:

• Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders.
• Facilitate and complete inpatient and outpatient coding audits.
• Communicates audit results both verbally and in writing in an approved appropriate format.
• Assist with the development and coordination of audit plans, feedback to coding staff and management to include query opportunities, documentation opportunities, accurate code assignment (ICD-10-CM/PCS, CPT, HCPCS), accurate payment groupings (DRG, APC), accurate modifier assignment, accurate POA assignment, accurate discharge disposition assignment, compliance, and data management.
• Assist with chart sample selection to ensure coding audits are appropriate and effective.
• Assist with the development of internal and external Coding Integrity Work Plan.
• Performs trend analyses to identify patterns and variations in coding practices and case-mix index, which require education.
• Meets or exceeds an audit accuracy rate of 95%.
• Work collaboratively with Coding Operations, Clinical Documentation, Medical Staff, Leadership, Education, PFS, Revenue Integrity, Ancillary Departments, and other key stakeholders to provide education, training, or information on accurate and ethical coding and documentation standards, guidelines, and regulatory requirements.
• Prepares agendas, job aids, and educational training material, and maintains meeting minutes for meetings, training, and other business needs.
• Able to work independently in a remote setting, with little supervision.
• Excellent interpersonal and communication skills to deal with staff and co-workers are required.
• Adept at reading, writing, mathematics; multi-tasking; work well within stressful environments; have strong cognitive and problem–solving skills, all with minimal supervision.

Job Requirements:

Education/Skills

• High School Diploma or equivalent years of experience required
• Graduate of an accredited Health Information or Health Informatics Management program preferred

Experience

• 5 or more years of Inpatient and/or Outpatient coding experience in an acute care setting preferred
• Experience conducting training/educational sessions for professional staff, including preparation of instructional materials
• Experience with physician documentation and audit experience
• Experience performing and evaluating coding audits & quality performance required
• Excellent written and oral communication, and analytical skills are required
• Extensive knowledge of ICD-10-CM/PCS, CPT, and HCPCS coding principles and guidelines, and reimbursement systems - MS-DRG, APR-DRG, and APC assignments required
• Must possess a general working knowledge in internal integrity requirements and procedures
• Extensive knowledge of federal, state, and payer-specific regulations and policies pertaining to documentation, coding, privacy, and billing is required
• Ability to create and interpret reports and provide guidance on studies and government regulations, and guidelines related to HIM is required
• Knowledge of information systems, healthcare applications, Microsoft applications, and database applications is required

Licenses, Registrations, or Certifications

• One of the following is required
  • CCS AHIMA
  • RHIA AHIMA
  • RHIT AHIMA

Work Schedule:

5 Days - 8 Hours

Work Type:

Full Time