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About Emerson Hospital: Emerson Hospital is well-known for its outstanding nursing care and patient-centered facilities including the Birthing Center and special nursery care. A Level II Special Care Nursery enables Emerson Hospital to care for moderately ill newborns. It is the only special care nursery in the area, which provides 24-hour in-house coverage by pediatricians and anesthesiologists. Emerson's core mission has always been to make high quality health care more accessible to those who live and work in its service area. While Emerson provides all of the services that most patients will ever need, the hospital's strong relationships with the downtown academic medical centers ensures that our patients have access to world class resources. At Emerson Hospital, it's beyond compare. You'll find lower patient ratios, ample continuing education opportunities, a collaborative environment with physicians and staff, and state-of-the-art technology. Job Description CLINICAL CODING VALIDATOR EDUCATOR
CLINICAL CODING VALIDATOR EDUCATOR HEALTH INFORMATION MANAGEMENT Full Time, Day shift Job Summary: Under the general director of the Manager, Clinical Documentation and Coding, this position is responsible for performing quality reviews of records for documentation and coding to validate the ICD-9-CM/CPT4 codes, and DRG assignments appropriateness to ensure consistency and efficiency in claims processing and data collection for the hospital. Based on these findings, assists the Manager, Clinical Documentation and Coding with the development of process improvements to maintain data quality. Job Functions: § Provides ongoing auditing and educational support to coding staff, physicians and other clinicians to assure appropriate assignment of ICD-9-CM, CPT4 codes and DRG assignment according to hospital and applicable coding guidelines. § Performs data quality reviews on records to validate the ICD-9-CM/CPT4 codes, DRG assignment appropriateness, missed secondary diagnosis which impact patient severity, procedures and ensures compliance with all regulatory mandates. § Monitors Medicare and other reimbursement bulletins and manuals. Reviews current OIG work plans for coding risk areas. § Create and monitor inpatient case mix reports and the top 25 assigned DRG’s in the facility to identify patterns, trends, and variations in the facility’s frequently assigned DRG groups. Evaluate the cases of the change or problems and reports variances to the Manager, Clinical Documentation and Coding. § Continuously evaluates the quality of clinical documentation to spot incomplete or inconsistent documentation for inpatient encounters that impact the code selection and resulting DRG assignment and payment. Reviews identified concerns with the Manager, Clinical Documentation and Coding and Clinical Documentation Specialists. § Evaluates records and responds to the PRO DRG changes, Blue Cross Audits and denial notices. Reviews with Manager, Clinical Documentation and Coding, prepares appeal letters, identifying appropriate documentation and references when appropriate. § Acts as administrative and clinical educator, resource person for the dissemination of DRG interpretation departmentally, in conjunction with the Manager, Clinical Documentation and Coding. § Conducts educational sessions with physicians regarding documentation requirements for prospective payment systems as well as identifying data elements to be collected to meet internal and external data needs. § Acts as a contact person for the concurrent review process conducted by the case managers for coding questions, DRG assignments, and provides education to coding/DRG changes found in the random/focused review and quarterly coding changes in conjunction with the Manager, Clinical Documentation and Coding. § Liaison between Revenue Cycle Departments, Case Management, Clinical areas and Coding to research and resolve coding/billing issues. § Assists the Manager, Clinical Documentation and Coding in preparing productivity reports and participates in department’s total quality management processes. § Assists the Manager, Clinical Documentation and Coding to implement new systems, policies and procedures in the Coding area. § Serves as the facility representative for documentation/coding/DRG information by attending coding and reimbursement workshops and brings back information to the appropriate departments. Communicates updates published in third-party payer newsletters and bulletins and provider manuals to all facility staff that need this information. § Demonstrates competency in the use of computer applications and coding/grouper software, Medicare edits, and all coding and abstracting software currently in use in the HIM department. § Reviews and references available resource material on a continuous basis. § Recognizes and understands the role of a coder in the department and how it relates to the overall function of the hospital regarding patient care, case-mix and fiscal reimbursement. § Maintains and supports patient’s rights to care, privacy and respect. § Other duties as assigned from time to time Minimum Qualifications: Education: § College degree required; Degree in Health Information Management preferred Experience: § Minimum of 5 years of progressive coding experience. § 3 years management experience. § Previous technical and supervisory experience in medical record/coding functions; § Previous revenue cycle experience. Licensure and/or Certification: § Certified Coder Required, RHIA/RHIT certification preferred. Knowledge and Skills § Extensive knowledge of medical terminology, anatomy and physiology, and disease processes. § Broad knowledge of Federal, State and payer-specific regulations and policies pertaining to documentation, coding and billing. § Ability to read and interpret regulatory guidelines with regard to proper coding and documentation. § Strong computer skills to include MS Office tools (Word, Excel, PowerPoint, and Outlook); previous 3M Encoder and Meditech experience preferred. Extensive use of computer and office equipment including fax, copy machines, scanners. § Technical skills to work with detailed systems, computer applications and intradepartmental units § Knowledge of JCAHO requirements and federal and state guidelines applicable to health record completeness and patient privacy. § Knowledge of health information systems and data management § Knowledge of health record content and sequence. § Strong analytical and communications skills; detailed oriented. § Ability to use judgment in carrying out all phases of the work. § Ability to accept constructive analysis based on feedback from inside/outside auditors, and quality improvement initiatives § Ability to maintain confidentiality with regard to all phases of the work. § Ability to be courteous, tactful, and cooperative throughout the working day. § Ability to process and provide accurate paperwork. § Ability to process work within presented deadlines and time frames. § Ability to manage multiple projects and large amounts of data. § Ability to work independently as well as a team player. § Demonstrated interpersonal and communications skills to ensure effective outcomes in dealing with the medical staff and other hospital employees. § Subject to irregular hours occasionally. Interested applicants should apply online at: www.emersonhospital.org Or, submit resume to: Emerson Hospital Human Resources 133 ORNAC Concord, MA 01742 EOE Requirements Bachelor's Degree
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