CODING QUALITY AND RECONCILIATION COORDINATOR SENIOR

To provide training and education to coders to advance skill and/or maintain competency.  Additionally this position is necessary to maintain and enhance the quality program to ensure compliance with regulatory standards.

1.  Maintain and enhance the quality review program for coding.  

• Regularly scheduled quality reviews – developing a new standard Quality review process

• Coding – using EPIC WQ’s or system as assigned

• By coder

• By DRG

• Focused 

 

1. Evaluate results from external reviews.

 

3.  Develop, implement and maintain an ICD-10 Inpatient training program for all current and new staff. 

• Assist in ICD-10 training, monitoring of implementation and future processes

 

4.  Maintain coding education and best practices for all coders.  

• Answer coding questions for Inpatient coders

• Research new/ambiguous codes; Stay up to date on Coding Clinics and Guidelines for coding

• Report trends at monthly meetings and inform coders of best practices for accurate coding

• Maintains claim edit work queues

• Liaison with physicians and service locations on documentation opportunities.

 

5.  Process Insurance Denials for coding changes in a timely manner

• Assist with appeal letters as necessary, showing justification for TCH coding 

• Maintain a record of all denials, appeals and results by coders

• Attend Quarterly Denial review meetings

 

Assist coding Leadership in any area deemed necessary   

 

7.  Other duties as assigned

KNOWLEDGE AND SKILLS:

Please describe any specialized knowledge or skills, which are REQUIRED to perform the position duties.  Do not personalize the job description, credentials, or knowledge and skills based on the current associate.  List any special education required for this position.

 

EDUCATION: Associate or bachelor's degree preferred

          

YEARS OF EXPERIENCE: 10+

          

REQUIRED SKILLS AND KNOWLEDGE: Demonstrated facilitation and presentation skills.  Ability to work collaboratively with medical staff (physicians), nursing and coding staff.   Superior communication skills.   System experience, critical thinking skills and problem-solving skills a must.  Advanced coding skills and an understanding of coding regulatory guidelines a must. 

 

LICENSES & CERTIFICATIONS:

The following certifications are preferred:

• Registered Health Information Administrator (RHIA)

• Registered Health Information Technician (RHIT)

• Certified Coding Specialist (CCS)

• Certified Coding Associate (CCA)

• Certified Coding Specialist Physician Based (CCS-P)

• Certified Professional Coder - Hospital (CPCH)

• Certified Professional Coder (CPC)