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Coding Compliance Specialist - Health Information - INTEGRIS

Company: INTEGRIS Health
Location: Oklahoma City
Posted on: April 8, 2021

Job Description:


Coding and Comp Specialist

Job Code: 1036

Position Summary:

The Coding Compliance Consultant analyzes relevant clinical and demographic information from the Health Information record, audits for appropriate ICD-9-CM and/or ICD-10 and CPT/HCPCS code assignment following appropriate guidelines and ascertains that the above are compliant with OIG, HCFA, JCAHO, Medicare, state and other regulatory agencies.

All applicants will receive consideration regardless of membership in any protected status as defined by applicable state or federal law, including protected veteran or disability status. INTEGRIS Health is an Equal Opportunity/Affirmative Action Employer.

Essential Functions:

The Coding Compliance Consultant responsibilities include, but are not limited to, the following:

* Reviews commercial and governmental coding denials and initiates the appeal process, when applicable, working closely with the denials management team.

* Reviews coding compliance concerns as related to National Coverage Determinations and Local Coverage Determinations and initiates staff education on such matters as necessary.

* Performs quality assurance and training audits to support coding staff.

* Provides on-going training and education to coding staff.

* Reports statistics concerning coding accuracy levels.

* Assigns codes proficiently and analyzes documentation for appropriate severity of illness and risk of mortality reporting.

* Completes analysis of documentation, abstracting and code assignment by body system, organ, etiology and morphology according to the American Hospital Association Official ICD-10 Coding Guidelines (Coding Clinic), CPT4/HCPCS Coding Guidelines, ASC groups, UHDDS Guidelines, HCFA methodology guidelines for coding, state and federal guidelines and hospital abstracting guidelines

* Coordinates documentation needs with CDI Team, including initiation of query process, query follow-up and final DRG assignment.

* Performs data analytics to mine for coding and documentation opportunities, performs gap analysis, and puts performance improvement initiatives into place.

Accountability:

Reports to the System Manager Clinical Coding.

Required Physical Demands (Subject to Reasonable Accommodation):
Keyboarding/Dexterity: Frequently; activity exists from 1/3 to 2/3 of the time
Standing/Walking: Occasionally; activity exists up to 1/3 of the time
Strength (Lift/Carry/Push/Pull): Sedentary (exerting up to 10 pounds of force occasionally)
Talking (Must be able to effectively communicate verbally): Yes
Seeing: Yes
Hearing: Yes
Color Acuity (Must be able to distinguish and identify colors): No

This position may have additional or varied physical demand and/or respiratory fit test requirements. Please consult the Physical Demands Project SharePoint site or contact Risk Management/Employee Health for additional information.

Environmental Conditions:

Hazards are minimal if safety precautions are utilized. Heavy work volume, high degree of accuracy required and stringent deadlines. Exposure to serious error is present: data integrity, health information security /confidentially. May be required to work extended hours, on off shifts and weekends/holidays related to deadlines and needs of System departments. Travel may be required to INTEGRIS facilities. Exposure to weather conditions during travel.

Qualifications:

* Knowledge of medical terminology, anatomy and physiology, coding and application

* Knowledge of various computer applications including Windows, Excel, hospital information systems and encoders

* One of the following:

* CCS: Certified Coding Specialist Certification and three years of coding experience

* CPC: Certified Professional Coder and three years of coding experience

* RHIT: Registered Heath Information Technologist Certification. Requires Associate Degree and two years of coding experience

* RHIA: Registered Health Information Administrator Certification. Requires Bachelor Degree and one year of coding experience

* Must be able to communicate effectively in English (Oral/Written)

Keywords: INTEGRIS Health, Oklahoma City , Coding Compliance Specialist - Health Information - INTEGRIS, Healthcare , Oklahoma City, Oklahoma

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