The Coding Compliance and Education Coordinator conducts and coordinates ongoing educational programs and training for the Coding Unit and incoming clinical staff regarding MS DRG/ICD (International Classification of Diseases)/CPT (Current Procedural Terminology)/APC updates. Responsible for developing the annual coding education plan.
Responsible for communicating regulation, policy, and guideline changes to affected personnel. Serves as a resource for department managers, staff, physicians, and administration on accurate and ethical coding and documentation standards, guidelines and regulatory requirements and assists in the development of structural documentation tools. Creates or revises policies and procedures based on current regulatory changes and authoritative advice or advises leadership on such. Serve as a subject matter expert and authoritative resource on interpretation and application of coding rules and regulations and conducts risk assessments of potential and detected compliance deficiencies.
Develops and provides educational and training programs regarding elements of the coding compliance program, such as appropriate documentation and accurate coding, to all appropriate personnel, including SHC coding staff, physicians, billing personnel, and ancillary departments. Provides training to newly-hired coding staff; provides unit orientation to contract coders, monitors performance, and reports progress to management.
Evaluates the adequacy and effectiveness of internal and operational controls designed to ensure that coding processes and practices lead to appropriate execution of regulatory requirements and guidelines related to facility coding including federal and state regulations and guidelines, CMS (Centers for Medicare and Medicaid Services) and OIG (Office of Inspector General) compliance standards. Applies standardized scoring methodology to consistently evaluate coding accuracy and standardizes review findings and methodology to report monitoring results. Communicates review results to department management, coders and other appropriate staff. Makes recommendations to management for corrective action. Prepares written reports of coding review findings and recommendations and presents to management and maintains monitoring records.Researches, abstracts and communicates federal, state, and payor documentation, and coding rules and regulations; stays current with Medicare, Medi-Cal and other third-party rules and regulations, ICD and CPT coding updates, Coding Clinic guidelines; serves as subject matter expert and authoritative resource for the department and other SHC departments such as CDI and PFS. Assists with preparing for the ICD -10 implementation.
Assesses medical record documentation to meet coding compliance and other third party requirements and identifies documentation trends and issues to bring forward to management and Clinical Documentation Improvement Services for resolution. Assures accuracy and compliance of coding, MS DRG (Medicare Severity Diagnosis Related Group), and APC (Ambulatory Payment Classification) assignments.
Serves as a resource for department managers, staff, physicians, and administration to support accurate and ethical coding and documentation standards, and to gain information and/or clarification on institutional guidelines and regulatory requirements.
Conducts monthly prospective audits and coordinates ongoing monitoring of coding accuracy, coding productivity and documentation adequacy. Equal Opportunity Employer Stanford Health Care (SHC) strongly values diversity and is committed to equal opportunity and non-discrimination in all of its policies and practices, including the area of employment. Accordingly, SHC does not discriminate against any person on the basis of race, color, sex, sexual orientation or gender identity and/or expression, religion, age, national or ethnic origin, political beliefs, marital status, medical condition, genetic information, veteran status, or disability, or the perception of any of the above. People of all genders, members of all racial and ethnic groups, people with disabilities, and veterans are encouraged to apply. Qualified applicants with criminal convictions will be considered after an individualized assessment of the conviction and the job requirements.
Any combination of education and experience that would likely provide the required knowledge, skills and abilities as well as possession of any required licenses or certifications is qualifying.
Education: Bachelor's degree in a work-related field/discipline from an accredited college or university
Experience: Five (5) years of progressively responsible and directly related work experience
License/Certifications: CCS - Certified Coding Specialist, or RHIT - Registered Health Information Technician, or RHIA - Registered Health Information Administrator. ICD-10 Certified Trainer a plus.
Knowledge, Skills and Abilities
These are the observable and measurable attributes and skills required to perform successfully the essential functions of the job and are generally demonstrated through qualifying experience, education, or licensure/certification.
Ability to analyze and develop solutions to complex problems
You can apply judgment and make informed decisions
Ability to communicate effectively in written and verbal formats including summarizing data, presenting results
Ability to understand regulatory guidelines and official coding advice to ensure policies and procedures are current and compliant
Comply with the American Health Information Management Association's Code of Ethic and Standards of Ethical Coding and applicable Uniform Hospital Discharge Data Set (UHDDS) standards
Ability to demonstrate familiarity, knowledge and understanding of the principles and provisions of HIPAA (Health Information Portability Accountability Act)
Ability to establish and maintain effective work relationships
Ability to manage, organize, prioritize, multi-task and adapt to changing priorities
Familiarity, knowledge and maintain understanding of current coding conventions as applicable to Health Information Management
Demonstrate familiarity, knowledge and understanding of health information systems for computer application to Health Information Management and hospital revenue cycle
You can demonstrate familiarity, knowledge and understanding of ICD-10-CM & CPT-4 coding conventions expertise to code medical record entries; abstract information from medical records; read medical record notes and reports; select accurate codes for assignment and grouping to appropriate Diagnosis Related Groups
Ability to demonstrate familiarity, knowledge and understanding of MS DRG/APC reimbursement
Ability to demonstrate familiarity, knowledge and understanding of standards and regulations pertaining to the maintenance of patient medical records; medical records coding systems; medical terminology; anatomy and physiology and study of diseases
Ability to demonstrate knowledge and understanding of privacy regulations and confidentiality when dealing with confidential information and data