PURPOSE OF THIS POSITION
The quality of work produced by the Coding Integrity Specialists is critical to the success of BVHS as the coded data represents the organization for a variety of purposes. Translation of clinical documentation into coded data must be an accurate and complete representation of the patient's episode of care, which affects quality scores, hospital and physician profiling, appropriate reimbursement, statistical data reporting, and mitigation of compliance risks.
The purpose of the HIS Coding Integrity Specialist I is to assign diagnosis(es) and/or procedure codes to patient encounters utilizing ICD and/or CPT classification systems, as appropriate. The primary focus of this position is to code Emergency Department, Outpatient Clinicals (Ancillary and/or Professional) and may include leveling of appropriate E/M charges as well as verification of charges (CPT codes) that are being entered by the departments and providers are accurate. Other responsibilities also include abstracting of accounts, resolving claim edits appearing in encoder software, researching coding issues, querying the physician, and being an active participant on the coding team to insure the highest quality of coded data.
Duty 1: Utilizes the Encoding system for proper assignment of all diagnosis and procedures ICD and/or CPT codes which is supported by provider documentation. Abstracts all data required by the hospital wide information system and departmental policies.
Duty 2: Meets quality standards. Follows ethical coding practices and regulatory requirements mandated by the Federal Government, regulatory agencies and internal policies. Actively participates in external/internal review activities and departmental education regarding coding and reimbursement. Remains current and apply regulatory/coding changes, as appropriate.
Duty 3: Assesses adequacy of documentation in order to support accurate, complete and specific code assignment of principal and all secondary diagnoses and procedures. Appropriately queries provider for clarification or additional documentation needed. Respond to inquiries regarding coding and reimbursement activities.
Duty 4: Meets departmental productivity standards. Maintains efficient and appropriate balance between coding and support functions. Submits weekly productivity reports to manager or supervisor in a timely manner.
Duty 5: Resolves coding-related edits in a timely manner; completes tracking spreadsheet and updates to billing in edit software. Collects/tracks data for follow-up and education to insure timely coding of accounts and reporting of information, as appropriate
Duty 6: Requests instruction on all equipment systems and software which are unfamiliar or new in order to gain optimum competency. Reports any suspected system issues to appropriate individual/department. Reports any suspected data integrity issues, as appropriate.
Duty 7: Maintains a close working relationship with Revenue Integrity, Patient Financial Services, other Revenue Cycle departments, clinical departments and offices, and medical staff. Participates in departmental cross training, quality reviews, and project activities as assigned.