Coding Integrity Specialist - Education/Auditing

New to OU Health? Ask your recruiter about our competitive wages and total rewards package!

This Coding Specialist role is unique in that it works with physicians and other team members to educate on coding processes and practices while also being auditors and working in tandem with the compliance space. Due to the nature of the broad spectrum of areas involved, strong efficient communication and ability to look at the 'big picture' are a necessity.

General Description:

Reviews and evaluates hospital outpatient medical record documentation to assign, sequence, edit and/or validate the appropriate ICD-10-CM and Healthcare Common Procedure Coding System/Current Procedural Terminology (HCPCS/CPT) codes. Performs coding and/or code validation across OUH. Applies all appropriate coding guidelines and criteria for code selections.

Essential Responsibilities:

Responsibilities listed in this section are core to the position. Inability to perform these responsibilities with or without an accommodation may result in disqualification from the position.

• Using, ICD-10-CM and/or HCPCS/CPT, primarily assigns, validates, and/or edits codes the following patient types:

  • Same day surgery (SDC)

  • Observation (OBV)

  • Wound Care

  • Outpatient Cardiac Cath

• As needed, may also assign, validate, and/or edit codes for the following patient types:

  • Emergency department (ED)

  • Recurring (RCR)

  • Clinical (CLI) records, and/or

  • Provider Office Visit (POV)

• Assigns, validates, and/or edits procedure categories, modifiers (when applicable)

• Maintains or exceeds established productivity standards

• Maintains or exceeds established accuracy standards

• Initiates, validates, and/or edits physician queries in compliance with Company policy where appropriate

• Reviews all official data quality standards, coding guidelines, Company policies and procedures, and clinical/medical resources to assure coding knowledge and skills remain current

• Utilizes the complete medical record documentation in code assignment, validation, and/or editing of codes

• Follows all applicable coding guidance in assigning, sequencing, validation, and/or editing of codes

• Meets all educational requirements as stated in current Company policy

General Responsibilities:

• Performs other duties as assigned

Minimum Qualifications:

Education: High School Diploma or GED required.Associate's or Bachelor's degree in HIM/HIT preferred.

Experience: 3-5 years of experience in acute care observation and/or same day surgery hospital outpatient coding required.

Licensure/Certifications/Registrations Required: Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Coding Specialist (CCS), Certified Professional Coder (CPC), Certified Outpatient Coder (COC), NHA CBCS or equivalent coding certification from AHIMA or AAPC required.

Knowledge, Skills and Abilities:

• Coding Technical Skills- ICD-10-CM, HCPCS/CPT-4, and APCs.

• Analytical Skills - effective evaluation, synthesis and use of information gathered.

• Organization - establishing courses of action to ensure that work is completed efficiently; proactively prioritizes assignments and keen ability to multi-task.

• Communication - communicates clearly and concisely.

• Customer Orientation - establishes and maintains long-term customer relationships, building trust and respect by consistently meeting and exceeding expectations.

• PC Skills - demonstrates proficiency in Microsoft Office applications and others as required.

• Quality Orientation - accomplishing tasks by considering all areas involved, no matter how small; showing concern for all aspects of the job; accurately checking processes and tasks; being watchful over a period of time.

• Work Independently - is self-supporting; not needing to rely on others to complete a job.

#cb