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Coding Audit & Compliance: Perform pre-bill reviews of coded accounts to validate code assignment and identify missed opportunities or inaccuracies. Conduct retrospective reviews of high-risk coding areas and regularly scheduled audits for compliance with: Official Coding Guidelines, CHOP internal guidelines, AHA Coding Clinic for ICD-10 HCPCS, CPT-4, and AMA CPT Assistant. Audit records to identify documentation improvement opportunities related to: Severity of Illness (SOI) Risk of Mortality (ROM) APR-DRG and/or MS-DRG APC ICD-10-CM/PCS CPT-4 and HCPCS. Assist in the review of Hospital-Acquired Conditions (HACs) and other quality indicators for appropriateness. Identify anomalous coding or query practices and escalate to leadership.
Education & Subject Matter Expertise: Serve as a subject matter expert for coding practices and guidelines. Provide education to physicians, clinical documentation specialists, and coders based on audit findings and trends. Recommend and deliver targeted education based on identified coding or documentation trends. Stay current with all coding, documentation, and query guidelines and regulatory changes.
Reporting & Analysis: Organize and report audit findings regularly to leadership. Identify and communicate coding issues and trends to leadership. Recommend areas for education and process improvement. Track audit outcomes and maintain documentation for compliance and quality assurance.
Collaboration & Departmental Support: Collaborate with CDI specialists, providers, and billing teams to resolve discrepancies and improve documentation. Adhere to all internal policies, procedures, and guidelines of the Coding and Clinical Documentation Integrity department. Set goals and prioritize work using available resources efficiently and effectively. Participate in Quality Improvement initiatives and represent the Coding team on relevant committees.
Training & Documentation: Develop and maintain standardized orientation training for coding and documentation. Track training completion metrics and escalate unmet training needs. Create enterprise documentation tip-sheets in collaboration with other stakeholders. Track recurring deficiencies and recommend EMR template updates.
Associates Degree Health Information Management or related field - Required Bachelor's Degree Health Information Management or related field - Preferred
At least five (5) years inpatient and outpatient coding experience - Required At least two (2) years experience performing coding audits - Preferred
Ability to lead a team for projects. Advanced knowledge of complex surgical coding. Advanced knowledge of ICD-10-CM and ICD-10-PCS. Advance knowledge of the APR-DRG system. Knowledge of the MS-DRG system. Knowledge of the revenue cycle functions. Experience with encoder software such as 3M CRS and/or 3M 360 CAC. Familiarity with electronic health records (EHR), preferably Epic experience. Proficiency with Microsoft Office products such as Microsoft Office and Excel. Excellent verbal and written communications skills. Excellent interpersonal skills. Strong critical thinking / problem-solving skills. Strong analytical skills. Ability to maintain confidentiality and professionalism. Ability to work independently with minimal supervision. Ability to gather, analyze and make recommendations/decisions based on data. Ability to convey complex or technical information in an easy-to-understand manner.
Registered Health Information Technician (RHIT) - American Health Information Management Association - upon hire - Required or Registered Health Information Administrator (RHIA) - American Health Information Management Association - upon hire - Required Certified Coding Specialist (CCS) - American Health Information Management Association - upon hire - Preferred or Certified in Healthcare Privacy and Security (CHPS) - American Health Information Management Association - upon hire - Preferred
To carry out its mission, CHOP is committed to supporting the health of our patients, families, workforce, and global community. As a condition of employment, CHOP employees who work in patient care buildings or who have patient facing responsibilities must receive an annual influenza vaccine. Learn more. Children's Hospital of Philadelphia is an equal opportunity employer. We do not discriminate on the basis of race, color, gender, gender identity, sexual orientation, age, religion, national or ethnic origin, disability or protected veteran status.