Duties and Responsibilities of this Level:

A.  Monitor data quality and optimal reimbursement to the hospital by performing concurrent and prospective quality reviews for accurate coding and sequencingCD-10-CM diagnoses and ICD-10-PCS or CPT-4 procedures (and appropriate use of modifiers) for inpatient and outpatient services using Center for Medicare and Medicaid coding guidelines, standards and regulations. 

- 35% of time spent

•  Interpret guidelines, applicable laws, and regulations concerning hospital coding published in AHA Coding Clinic, AMA CPT Assistant, Federal Register, Medicare Bulletin, etc.  Develop and maintain specific coding guidelines for inpatient and outpatient coding.  Research problem areas and develop training material and coding aids for the coders.  

• Present timely, relevant educational programs to coding staff regarding coding updates, documentation, and prospective payment system requirements.  Participate in the training of the coders and evaluate the effectiveness of the training.

•  Maintain/update the coding compliance manual.
• Monthly report on findings to coding staff and others (including the Compliance Department).

B.  Identify coding and billing risk areas for the hospital technical charges, conduct focused reviews, report the results, and implement corrective action as needed.

- 30% of time spent

•  Serves as the technical expert for questions
•  Conduct routine internal audits of coded data and physician documentation, report the results, and recommend corrective action as needed
•  Respond promptly to external audits and implement corrective action as appropriate.

C.  Serve as a resource to the hospital on coding and documentation-related issues.  Educate physicians and other healthcare professionals regarding documentation requirements for accurate coding and reimbursement. Educate administration, Financial Management, Patient Resource Management, Revenue Managers, etc. regarding DRGs/APCs/APR-DRGs and the reimbursement methodologies.

- 30% of time spent 

•  Collaborates with HB Coding, Billing, and others for process or system changes.
• Participates in the creation and execution of educational initiatives associated with HIM strategies
•  Effectively communicates verbally and in written form, including the provision of updates to the Associate Director and  Director regarding the operation of the work unit, project status, and staff issues

D.  Other - 5% of time spent

• Performs other related duties incidental to the work described herein and performs other related work as required