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Rush University Medical Center Senior Compliance Coding Analyst - Health Information Management in Chicago, Illinois

Job Title:

Senior Compliance Coding Analyst - Health Information Management

Department:

Health Information Management

Shift:

1st

Full/Part:

Active Regular FT (72 to 80 hours per pay period)

Specialty:

Coding

Job Number:

2021-0826

Job Description:

Senior Compliance Coding Analyst

Health Information Management Department

Position Highlights:

This position is responsible for continuous monitoring of the coding quality performed by staff both within and external to the Health Information Management Department. Provides educational programs to both physicians and coding personnel to improve coding quality. Prepares various reports for administration and the Compliance Council. Represents Health Information Management and RUMC at forums that are internal and external to the medical center. Maintains a demeanor and appearance appropriate for representation of RUMC. Exemplifies the Rush mission, vision and values, and acts in accordance with Rush policies and procedures.

Position Responsibilities:

  • Conducts ongoing quality and compliance reviews of coding throughout the Medical Center that impacts Hospital billing.

  • Ensures all departmental coding policies/procedures/guidelines are current and followed.

  • Manages documentation of the employee training process.

  • Assists Director and Coding Manager in development of quality, performance and productivity standards for the Health Information Management Department, assist in ensuring all function/work is reviewed on a regular, ongoing basis and reported to Department Management.

  • Provides periodic refreshers, updates, and orientations for staff to ensure compliance with Hospital and JCAHO requirements. In-services staff routinely on compliance issues.

  • Ensures compliance by all coding and coding support staff with all applicable federal, state, local and accrediting agency regulations.

  • Fills in for Technical Leads in their absence.

  • Prudently uses department resources and supplies and reports any equipment malfunctions promptly.

  • Assesses operations and make recommendations for improvement. Implement recommendations as directed.

  • Reports monthly, or more frequently, on achievement of/compliance with department goals.

  • Demonstrates the ability to work as part of the management team.

  • Sets example for staff supervised in such areas as professionalism, demeanor, customer service, dress and appearance, and work ethic.

  • Demonstrates technical expertise on coding issues.

  • Manages the resolution of all billing rejections due to coding issues.

  • Participates in external auditor review process and billing corrections.

  • Completes other assigned duties as determined by director.

APC Coding Compliance Coordinator:

  • Monitors various regulatory sources to keep HIM coding and management staff informed and trained on APC coding rules, regulations, and related issues. Provides same training to all Outpatient Clinic coding staff.

  • Through daily auditing, identifies coding-related APC losses and variances as well s compliance-related issues. Prepares and implements appropriate corrective action to rectify both regardless of source. Prepares written reports to the Compliance Department as appropriate.

  • Works closely with Patient Financial Services to resolve any claim denials related to coding performed by HIM or outpatient clinic-coding staff.

  • Assess accuracy of codes printed on encounter forms, updates as necessary.

  • Assist in updating the chargemaster.

  • Performs periodic claim form reviews to check code transfer accuracy from the abstracting system through the billing system.

  • Educates physician staff on documentation requirements to support codes assigned to claims.

  • Periodically audits the accuracy of evaluation and management codes compared to the documentation in the record.

  • Participates on various Medical Center billing, coding and compliance related committees.

  • Performs various tests to ensure system is functioning properly and all staff is trained on new functionalities as new updates to coding system are installed.

DRG Coding Compliance Coordinator:

  • Monitors various regulatory sources to keep HIM coding and management staff informed and trained on DRG coding rules, regulations, and related issues. Provides ICD-10-CM/PCS coding training to Registration staff and others as required.

  • Through daily auditing, identifies coding-related DRG losses and variances as well as compliance-related issues. Monitors both Medicare and non-Medicare cases for coding accuracy. Prepares written reports to the Compliance Department and management as appropriate.

  • Works closely with Patient Financial Services to resolve any claim denials related to coding performed by HIM staff.

  • Assists in updating the chargemaster.

  • Performs periodic claim reviews to check code transfer accuracy from the accuracy from the abstracting system through the billing system.

  • Performs various tests to ensure system is functioning properly and all staff is trained on new functionalities as new updates to coding system are installed.

  • Educates physician staff on documentation requirements to support DRGs and coding assigned to claims.

  • Audits physician and non-physician (therapists, etc.) documentation in the record for completeness and timeliness periodically.

  • Participates on various Medical Center billing, coding and compliance related committees.

  • Prepares various appeal letters and responses to queries or errors noted by external auditors.

Position Qualifications Include:

Knowledge:

  • RHIA or RHIT preferred, CCS credential preferred, and/or Bachelors of Science degree in a related field, Associates in Health Information Technology minimum acceptable.

  • 5 or more years of outpatient, E&M, and inpatient coding experience.

  • Progressively responsible experience in Health Information Management with no less than 3 years as a Senior or Lead Coder

Skills:

  • Demonstrates competency in use of computer applications including abstracting and encoding software, APC and DRG grouper software, MS office and hospital information systems.

  • Understands Outpatient Code Editor edits.

  • Understands QIO requirements and PEPP reporting.

  • Outstanding organization and teambuilding skills.

  • Reports writing and public speaking skills required.

Abilities:

  • Ability to write clear, concise reports for senior administration, management, and the medical staff.

  • Ability to educate others and confidence in presentation skills to both small and large groups of individuals.

  • Ability to apply local, state, and federal guidelines with attention to detail.

Company Highlights:

  • Rush University is known for its high-quality health care education, supportive learning environment, engagement with the urban community and forward-looking education approach.

  • Rush University's Family Nurse Practitioner program is ranked in the top six in the nation by U.S. News & World Report.

  • Rush University is ranked 22nd on the Times Higher Education's 2016 list of the world's top 150 universities under 50 years of age.

Rush is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, and other legally protected characteristics.

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