Duties and Responsibilities of this Level:
 
·         Monitor and track performance to ensure quality and quantity of work performed through regular audits and QC for Coding and Non-Coding staff
·          Review and research complex medical records and/ or problematic coding that needs research and reference checking, and accurately codes, or guide coders for the primary/secondary diagnoses and procedures using            ICD-10 CM and/or CPT, HCPCS coding conventions, and payer-specific coding guidelines
·          Develop and assist with training, presentations, and educational tools for any relevant topic as it relates to continuing education programs in areas of specialization, coding, operational workflow, and quality control
·         Collaborates with other departments and partners (e.g. Revenue Integrity, QA Team, Compliance Specialists, Internal Controls, Billing and Collections, Revenue Managers, Coding Managers, and departmental                   leadership) to ensure optimized process and workflows
·         Consult with and provide feedback to physicians or departments on coding practices and conventions to provide detailed coding information. Communicate with clinical, ancillary staff, and Revenue Managers for needed documentation to ensure accurate coding
·          Develop and maintain a thorough understanding of anatomy and physiology, medical terminology, disease processes, and surgical techniques through participation in continuing education programs to effectively apply              ICD-10 CM and CPT coding guidelines to inpatient/outpatient diagnoses and procedures for both the Hospital and Professional claims
·         Develop and maintain a thorough understanding of medical record practices, standards, regulations, Health Care/Finance Administration (HCFA) and Uniform Billing (UB-04), CMS, and other payer policies and any                    healthcare-relevant changes
·         Develop and maintain a thorough understanding of payer-specific guidelines as it pertains to charge capture, edit review, denial management, and reporting
·         Attend various meetings with stakeholders, serving as a subject matter expert or as a Coding Operations delegate
·         Assist with Service Now ticket submissions for system logic updates
·         Ensure compliance with PRMO and DUHS policies and code of conduct
·         Ensure that the department's operations adhere to the laws regulating the healthcare industry (i.e. CMS, Medicare, Medicaid, HHS, OIG, JCAHO)
·         Assist with special projects as required
·         Perform other related duties incidental to the work described herein
 
·         Coding and Non-Coding Quality Control (30%)
o     Review of Coding and Non-Coding staff to identify erroneous coding patterns and errors and provide feedback and education to address issues found
o    Monitor and track QA results by implementing the QA process in collaboration with the Revenue Integrity Team
o    Provide coding process analysis and support for the department as an expert for the PB Coding Medicine/Radiology/Charge Capture/Charge Resolution team Identify coding and documentation trends for use in the education of coding staff and providers
o    Review monthly QA report with the Coding Manager for quality  accuracy of coding staff members and team in aggregate
o     Review complex coding as a subject matter expert to provide additional guidance as needed
o    Implement and maintain Compliance programs focusing on work by Coding Operations by the Office of Inspector General's work plan, to reduce institutional and individual provider legal and financial risk through education and internal audits

·    Coding Education, Newsletter, and Team Development (40%)
o    Educate internal coders regarding compliance with government regulations with special attention to Center for Medicare and Medicaid guidelines as they pertain to academic medical centers, HIPAA, and Fraud and Abuse with periodic updates.
o    Plan activities, including specialty pod meetings, aimed at improving the quality performance of the PB Coding Medicine/Radiology/Charge Capture/Charge Resolution team and vendor coders. Design and implement strategies for enhancing the PB Coding Medicine/Radiology/Charge Capture/Charge Resolution te am and increasing productivity
o    Evaluate the effectiveness of improvement strategy through sustained tracking and monitoring of PB Coding Medicine/Radiology/Charge Capture/Charge resolution team WQs
o    Reporting of PB Cod ing Medicine/Radiology/Charge Capture/Charge Resolution team performance to the Coding Manager
o    Assist with research, development, and presentation of continuing education programs for specialty areas
o    Collaboration with the CS team on quarterly education sessions in Director All Staff Meetings and on quarterly coding newsletters
o    Maintain a thorough understanding of medical record practices, standards, and regulations, Joint Commission on Accreditation of Health Organizations (JCAHO), Health Care/Finance Administration (HCFA), Medical Review of North Carolina (MRNC), etc.

·         Vendor Relationships and Coding Onboarding (30%)
o    Manage vendor relationships through regular communications and routine audits of vendor coders. Communicate all internal controls and policies as applicable to the vendor coding team and mitigate any differences between vendor policy and University policy
o    Provide internal and vendor coder onboarding support to the Manager of Coding Operations - PB Coding Medicine/Radiology/Charge Capture/Charge Resolution 
o    Review of documentation guidelines for the coding of defined specialties for new employees or existing employees who are changing designated areas
o    Provide quality control review of internal and vendor coder onboarding cases and feedback to employee/supervisor regularly.
o    Provide a weekly summary to the Coding Manager / Supervisor on the progress of all employees