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Job Title:

Senior Coding Educator and Data Consultant

Department:

Health System Shared Services | MIM CDI and Coding

Scope of Position: The Senior Coding Education and Data Consultant ensures documentation and coding compliance at Ohio State University Wexner Medical Center. The Senior Coding Education and Data Consultant is responsible for conducting data analysis, generating and developing reports, auditing coding and medical record documentation, identifying improvement opportunities, and creating education plans for coders, CDIs, and providers. This role is expected to develop an action plan and influence adoption by effectively engaging coding, CDI, and providers.

The consultant evaluates performance to assess the quality of medical record documentation and coding, preparing recommendations based on the results. They monitor the case-mix index for services and hospital entities, Vizient and hospital-related quality initiatives (e.g., patient safety indicators, pressure ulcer monitoring, mortality reviews, etc.), and the Program for Evaluating Payment Patterns Electronic Report (PEPPER). These measures help identify opportunities for improvement and help ensure compliant coding. The consultant provides and presents detailed findings reports. The consultant will conduct in-depth reviews of billed codes, charges, and modifiers and report findings.

Moreover, the Senior Coding Education and Data Consultant serves as a subject matter expert on compliant documentation and coding opportunities. The Senior Coding Education and Data Consultant will guide root cause analysis, measure coding and reimbursement opportunities and risks, and then communicate these findings to the Director of Coding and Compliance, as requested by the Administration.

Position Summary: This position conducts health-system-wide coding analyses to promote compliance with federal and state regulations pertaining to but not limited to ICD-10-CM, ICD-10-PCS, and CPT-4 coding, assignment of modifiers, charge entry, and data abstraction for hospital billing and must understand the principles of physician documentation. Under the direction of the Director of Inpatient Coding and Compliance, the Senior Coding Education and Data Consultant assists in determining controls and monitors risk areas or changes to review risk management and ensure compliance with documentation and coding regulations. Consultant operates with extreme tact and diplomacy in performing job duties while interacting with faculty and staff from all areas of the Medical Center.

Duties and Responsibilities

75% of the time –Hospital Quality Initiatives, Audits and Data Analysis

• Reviews mortality cases in accordance with hospital coding guidelines and completes audit abstract of data elements in Epic
• Conducts and reviews coded accounts for other quality initiatives such as present on admission
• Tracks hospital quality reviews and collaborates with clinicians
• Routinely attends meetings with various Quality Department teams
• Designs and runs reports from the Information Warehouse, Vizient database, or using other available databases, including but not limited to MedPar data. Develops reports to analyze codes assigned and billed.
• Coordinates and conducts audits to investigate reported variances in the coding between the hospital and professional claims or missing or inaccurate modifiers or charges. Prepares detailed reports of find