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Responsible for educating and training WVU Healthcare Coding Staff as directed by Coding Managers. Will also oversee or perform the overall auditing and education plans for the Coding staff. Responsible for the overall auditing and education plans for the Coding staff. This position will perform coding quality audits, provide ongoing feedback and education. This position utilizes various coding classifications; ICD-10-CM, ICD-10-PCS, CPT, and other references and software to ensure accurate coding and MS-DRG, HCC and APR-DRG assignment.
Minimum Qualifications
Graduate of a Health Information Technology (HIT) or equivalent program AND Five (5) years of coding experience
Graduate of a Medical Coding Certification Program AND Five (5) years of coding experience
High School Diploma or Equivalent AND Eight (8) years of coding experience
Certification
Registered Health Information Administrator (RHIA) OR Registered Health Information Technician (RHIT) through American Health Information Management Association
Certified Outpatient Coder (COC) through American Academy of Professional Coders
Certified Coding Specialist (CCS) through American Health Information Management Association
Certified Professional Coder (CPC) through American Academy of Professional Coders
Preferred Qualifications
Bachelor’s degree in Health Information Management or related field
Extensive experience in ICD-10‑CM, ICD-10‑PCS, CPT, and MS‑DRG, HCC and APR‑DRG assignment for positions and multi‑specialty coding, E&M coding, procedural/surgical coding, as well as knowledge of governmental billing and coding regulations including the “Teaching Physician Guidelines” for Professional Coding Positions preferred
Previous supervisory or project management experience
Core Duties and Responsibilities
Manages activities of designated coding personnel in training for WVU Healthcare and assures the monitoring and reporting of respective employee’s developmental activity
Manages quality improvement audits and training of designated coding staff
Acts as expert coding resource not only to coders, clinical documentation improvement, providers and revenue cycle, but also to specialty groups and meetings
Acts as super user for all coding‑related Electronic Medical Record Systems necessary for accurate coding and EMR Data Governance; updates policies and procedures for those areas of responsibility and in‑services appropriate staff regarding changes in these areas
Develops and maintains coding related policies, procedures, query development, work queues and training materials in conjunction with management
Continually communicates with coding staff, medical staff, physician advisor, department chairman, and department administrators
Organizes, facilitates, performs, tracks, trends, and reports on internal quality reviews
Designs and uses audit tools (i.e. ROC) to monitor the accuracy of coding, documentation gaps, and billing performed by coding specialists
Coordinates audits performed by outside agencies by obtaining accounts to be reviewed, acting as a liaison between agency and HIM personnel to gather data to be reviewed, facilitating exit conferences with coding specialists, and providing final reports to coding manager (includes HIA quarterly audits, ROC Compass audits, etc.)
Coordinates coding/documentation denial reviews and facilitates appeal letter formation (includes RAC denials, insurance/3rd party payor denials, etc.)
Communicates regularly with coding leadership on activities, problems, coding and/or documentation issues and pending audits
Ensures audit (external and internal) recommendations are completed (i.e. coding education, coding changes, rebills)
Extracts and analyzes from various sources then develops action plan when necessary
Assists with onboarding of new coding specialists in regard to coding/quality related policies, audits and initiatives
Updates coding specialists on compliance and other regulatory changes
Keeps abreast of coding changes, state and federal regulations and coding resources (i.e. Coding Clinic)
If needed this position could be responsible for development and design of the curriculum for the WVU Healthcare Coding Certificate Program, as well as other special projects regarding the overall Data Governance of the EMR to enhance coding; utilizes all necessary systems as part of curriculum and educational courses and administers exams; involvement with testing and installation of system upgrades when necessary to assure curriculum is up‑to‑date
Physical Requirements
Must be able to sit for long periods of time
Must have visual and hearing acuity within the normal range
Must have manual dexterity needed to operate computer and office equipment
Must be able to lift, push or pull 10‑20 pounds
Working Environment
Standard office environment
Visual strain may be encountered in viewing computer screens, spreadsheets, and other written material
May require travel
Skills And Abilities
Excellent written and verbal communication skills, as well as interpersonal skills necessary to communicate effectively
Knowledge of related provider healthcare compliance, revenue cycle operations, and auditing techniques
Ability to mentor, educate and train others
Ensures quality and productivity standards
Ability to handle high stress and critical situations in a calm and professional manner
Ability to concentrate and maintain accuracy during constant interruptions
Independent decision‑making ability
Ability to prioritize job duties
Ability to adapt to changes in the workplace and work assignments
Organizational and time management skills
Knowledge of anatomy, physiology and medical terminology
Analytical and problem‑solving skills
Proficiency in office software programs, including medical record and billing systems
Ability to analyze complex data and reports
Additional Job Description
Scheduled Weekly Hours: 40
Other Information
Exempt/Non‑Exempt: Exempt
Shift: United States of America (Exempt)
Company: SYSTEM West Virginia University Health System
Cost Center: 548 SYSTEM HIM Coding Analysis
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