Job details
Job type full-time
Full job description
Boston medical center (bmc) is more than a hospitalIt`s a network of support and care that touches the lives of hundreds of thousands of people in need each yearIt is the largest and busiest provider of trauma and emergency services in new englandEmphasizing community-based care, bmc is committed to providing consistently excellent and accessible health services to all-and is the largest safety-net hospital in new englandThe hospital is also the primary teaching affiliate of the nationally ranked boston university school of medicine (busm) and a founding partner of boston healthnet - an integrated health care delivery systems that includes many community health centersJoin bmc today and help us achieve our vision 2030 which is a long-term goal to make boston the healthiest urban population in the world.
Position: manger, coding validation and quality assurance
Department: clinical documentation
Schedule: full time, 40 hours
Responsible for the professional development of the coding staff and for providing a hospital-wide educational program to assist coders in continued coding and documentation educationPerforms quality assurance reviews of inpatient and outpatient records to assess and report on the effectiveness of training programs and quality of codersProvides in-service training and feedback to coding staff regularly, including coding changes and updatesDesigns and implements programs on coding and clinical documentation audit and education to improve performance and efficiencyPartners with cdci management to develop appropriate guidelines regarding ip and op codingEnforces correct application of official coding rules and regulations and follows appropriate guidelines including coding clinicThe manger ip/op coding and qa/education may help represent the clinical documentation coding integrity (cdci) department at clinical meetings when requested to serve as a resource for coding guidelines and interpretation.
Essential responsibilities / duties:
Primary responsibilities under the direction of the director of clinical documentation coding integrity (cdci):
Training
Develop and maintain a facility-wide educational program for coders and cdi specialists in current positions to provide continuous feedback and education.
Participate in coding and documentation education with the cdci team for physicians and other professionals documenting in the medical record.
Creates presentations, develops learning materials, handbooks, and other training materials
Lead training sessions on current billing and coding information in the medical fieldCommunicate changes to cdci and other revenue cycle staff.
Provide mentoring and education to current coders to improve their current performance.
Communicates and advises the cdci and revenue cycle staff on coding and documentation principles.
Hold regular meetings to communicate new findings.
Manages claim edits and denials
Designs workflow processes to ensure maximum coding quality, efficiency and compliance
Monitors claim edit, denial, and quality reporting compliance
Training administration
Develop curriculum and training project plan, working collaboratively with validators and cdci leadership to identify areas of need.
Research updated coding information.
Training assessment
Perform quality assurance reviews to assess comprehension of training efforts.
Conduct coding reviews and training programs to assure coding quality.
Prepares activity statistics and quality assurance studies as required; participates in medical record documentation auditing to monitor physician and nursing compliance with regulatory requirements.
Coding support
Review and respond to coding questions.
Ensure billed service is being accurately coded.
Perform random chart audits.
Perform analysis of benchmarking profiles.
Provide continual coding updates.
Research coding issues that arise.
Codes diagnoses and procedures from the medical record using icd-10-cm and cpt-4/hcpcs classification systems.
Sequences diagnoses, procedures and complications by following icd-9-cm, uniform hospital discharge data set (uhdds), medicare, medicaid, and other fiscal intermediary guidelines.
Understands and reviews the optimization of hospital payment legitimately and ethically, based on approved coding guidelines and conventions.
Audits the abstract of medical data from the record to complete a discharge data abstraction on each patient; codes and abstract surgery, trauma, visits, etc.
Reviews charts for documentation and signature.
General
Responsible for the day-to-day management of the qa/education and coding denials/edits arm of the cdci department including work distribution for inpatient and outpatient validation as well as auditing and providing education to cdci staff.
Duties include managing, developing and mentoring a group of clinical coding specialists, with responsibilities for coding strategies, coding deliverables, and related projects.
Other responsibilities include interviewing, orientation, training and preparing evaluations; responsible for hiring, terminating and disciplining personnel as necessary.
Establishes staffing scheduling and assigns workloads and projects in accordance with appropriate volume increases and decreases.
Assists with coding complex inpatient accounts as priority and outpatient accounts as needed due to backlog, absences and month-end close utilizing technical coding expertise to assign appropriate icd-10-cm/pcs and cpt-4 codes.
Conducts quality reviews to validate coding and drg and apc/apg assignments to ensure compliance with coding guidelines.
Evaluates documentation for incomplete or inconsistent documentation in the record which impacts coding and drg and apc assignmentParticipates in documentation review as part of the clinical documentation and coding integrity program.
Initiates queries when necessary and monitors responsesAssists with clinical documentation and coding integrity audits.
Provides training to healthcare professionals, cdci, and revenue cycle staff in icd, cpt, hcpcs level ii coding guidelines, proper documentation guidelines and other information related to coding.
Develops long term strategies for improving efficiencies and increasing coding team`s productivity through use of central coding conventions and classification systems, influencing and educating the clinical community on topics of data collection and guidelines related to clinical coding.
Coordinates daily workflow of medical records, monitoring smart for outstanding accounts not validated that must be reviewed and assigns to coding staff as necessary.
Reports on accuracy of coding and abstracting.
Responsible for the tracking and response for coding accountabilities from internal and external sourcesThis would include rac coding reviews as well as other payer reviews.
Tracks overtime, absenteeism, hours worked, leaves and vacation/sick time for assigned staffReviews and approves timesheets to payroll.
Maintains knowledge of icd-10 and cpt classifications and coding of diagnoses and procedures.
Participates in coding and reimbursement meetings.
Follows established hospital infection control and safety procedures.
Maintains professional skills and knowledge of coding through attendance at in-service programs, conferences, workshops and other educational programs and by review of current literatureShares knowledge and learning experiences to staff.
Abides by the standards of ethical coding as set forth by the american health information management association (ahima) and adheres to official coding guidelines.
Performs other related duties as required.
Education:
Bachelor`s degree or equivalent combination of formal education and experience.
Certificates, licenses, registrations required:
Ccs and ahima certified icd-10 trainer credentials required.
Additional rhia, rhit, rn, or other coding credential is preferred.
Experience:
Must have at least five years of experience in coding; experience must include education/mentoring/trainingMinimum of five years acute care hospital experience coding with icd-9/10-cm/pcs and cpt-4, academic medical setting or trauma center preferredMinimum of three years management experience required; five years preferred.
Prior experience working claim edits and denials.
Knowledge and skills:
Excellent command of the icd-9/10-cm and cpt4/hcpcs coding conventions, e&m coding, diagnosis-related groupings (drg) and ambulatory patient groupings (apg) methodologyWork also requires concepts of human anatomy, physiology and pathology.
Excellent skill in providing hands-on education to cdci staff based on audit finding and need.
Strong knowledge of health records, computerized billing and charging systems, microsoft applications, data integrity, and processing techniques required.
Excellent organizational skills, including ability to multi-task, prioritize essential tasks, follow-through and meet timelines.
Ability to work with accuracy and attention to detail
Ability to solve problems appropriately using job knowledge and current policies/procedures.
Ability to work cooperatively with members of the healthcare delivery team and staff, ability to handle frequent interruptions and adapt to changes in workload and work schedule and to respond quickly to urgent requests.
Must be able to maintain strict confidentiality of all personal/health sensitive information and ensure compliance of hipaa rules and regulations.
Must possess extensive knowledge of hospital inpatient and outpatient reimbursement methodologies.
Work requires in-depth knowledge of medical terminology, icd-10-cm/pcs and cpt-4 coding conventions and knowledge of the various drg systems (cms drgs, ap-drg, and apr-drgs)Work also requires basic concepts of human anatomy, physiology and pathology.
Strong knowledge of health records, computer systems, microsoft applications, data integrity, and processing techniques required.
Ability to mentor, guide and motivate direct reports through demonstration of best practices and leading by example.
Excellent organizational skills, including ability to multi-task, prioritize essential tasks, follow-through and meet timelines.
Ability to solve problems appropriately using job knowledge and current policies/procedures.
Ability to maintain and enforce strict confidentiality of all personal/health sensitive information and ensure compliance of hipaa rules and regulations.
Must possess extensive knowledge of payer claim edits and payer denialsWork requires in-depth knowledge of medical terminology, icd-10-cm and cpt-4 coding conventions (including e&m coding), ambulatory patient classifications (apc), ambulatory patient groupings (apg) methodologies, and fiscal intermediary local coverage determinations, cms national coverage determinations and various other applicable coding regulations and law.
Req id: 20521
