PURPOSE AND SCOPE:
Conducts data quality audits of outpatient encounters to validate coding assignment is in compliance with the official coding guidelines as supported by clinical documentation in health record. Validates abstracted data elements that are integral to appropriate payment methodology. Provides feedback and education to coders. Escalates compliance, risk-related issues to expedite mitigation.
PRINCIPAL DUTIES AND RESPONSIBILITIES: Consults facility leaders and staff on best practices, methodology, and tools for accurately coding.
Chart Analysis, OP Coding Data auditing and validation: Reviews medical records for the determination of accurate assignment of all documented diagnoses and procedures. Adheres to Standards of Ethical Coding (AHIMA/AAPC). Reviews medical records for the determination of accurate assignment of all documented diagnoses and procedures. Reviews claim to validate abstracted data including but limited to discharge disposition which impacts reimbursement and/or MS-DRG assignment. Adheres to Standards of Ethical Coding (AHIMA). Reviews medical records to determine accurate required abstracting elements (facility/client/payer specific elements) including appropriate ESRD designation. Reviews medical records for the determination of accurate assignment of all documented ICD-10 codes for diagnoses and procedures. Uses discretion, experience and specialized coding training to accurately assign ICD-10 codes to patient medical records. Demonstrates ability to achieve accuracy and consistency in the selection of principal and secondary diagnoses and procedures. Demonstrates ability to achieve accuracy and consistency in abstracting elements defined by Fresenius policy. Reviews medical records to determine accurate required abstracting elements (clinic specific elements) including appropriate discharge disposition. Identifies and communicates documentation improvement opportunities and coding issues (lacking documentation, physician queries, etc.) to appropriate personnel for follow-up and resolution. Evaluates and prepares as indicated daily, weekly and monthly reports indicating quality levels and opportunities for charge capture and revenue maximization. Monitors, prepares and presents reports including, but not limited to, Medical Record Delinquency Rates, Clinical Pertinence, H & P Compliance, Operative Note Compliance Develops and delivers education to horizontal and vertical audiences on coding and charge capture. Stays current with AHA Official Coding and Reporting Guidelines, CMS and other agency directives for ICD-10 coding. Attends mandatory coding seminars on annual basis (IPPS and OPPS, ICD-10 and CPT updates) for outpatient coding. Quarterly review of AHA Coding Clinic. Attends or facilitates Quarterly Coding Updates and all coding conference calls. Other duties as assigned.
Additional responsibilities may include focus on one or more departments or locations. See applicable addendum for department or location specific functions.
PHYSICAL DEMANDS AND WORKING CONDITIONS: Ability to sit for extended periods of time. Must be able to efficiently use computer keyboard and mouse to perform coding assignments. Capacity to work independently in a virtual office setting or in clinic setting if required to travel for assignment. Duties may require bending, twisting and lifting of materials up to 25 lbs. Duties may require travel via, plane, care, train, bus, and taxi-cab.
EDUCATION: AHIMA or AAPC Credentials Associates degree in relevant field preferred or combination of equivalent of education and experience
EXPERIENCE AND REQUIRED SKILLS: 2+ years related experience. Must be detail oriented and have the ability to work independently Computer knowledge of MS Office Extensive knowledge of medical record documentation requirements mandated by Medical Staff Bylaws, Rules and Regulations State and federal regulations regarding patient confidentiality Excellent verbal/written communication and interpersonal skills Thorough/detailed knowledge of ICD-10 and CPT coding systems Skilled in formulating and writing statistical reports Skilled in performing quality assessment/analysis Must display excellent interpersonal skills Knowledge of disease pathophysiology and drug utilization Knowledge of MSDRG classification and reimbursement structures Knowledge of APC, OCE, NCCI classification and reimbursement structures