The following is a summary of the major essential functions of this job.  The incumbent may perform other duties, both major and minor, that are not mentioned below.  In addition, specific functions may change from time to time:

• Actively monitors and manages unbilled hospital DNB daily at or below administrative goals in an efficient, effective, and professional manner.

• Identifies and resolves issues that could lead to delayed or denied claims. Recommends improvements for workflows and automation to address trended issues.

• Communicates with HIM Coding Director with concerns/problems that are impacting ability in meeting billing targets.

• Monitors Coding Priority WQ in EPIC and work pools in eValuator to expedite completion of records that are high dollar or aged beyond min days.

• Assists with coding functions (retrospectively and concurrently) as needed to ensure ongoing and timely workflow.

• Assists Providers, Revenue Cycle Departments and Management to facilitate completion of all coding/billing requirements (ex: chart deficiencies, dates out of range, clarification of discharge disposition codes, ED/EC charge entry referrals for potential duplicates/no shows, etc.)

• Performs updates to provider SER records and manages WQs that qualify with accounts pending provider NPIs and other data elements required for timely claims filing.

• Performs system troubleshooting and testing for coding department.

• Other duties as assigned

Minimum Qualifications

The following qualifications, or equivalents, are the minimum requirements necessary to perform the essential functions of this job:

Education and Formal Training: 

• Associates Degree in Health Information Technology with a minimum of 5 years of related experience required OR

• Bachelor’s degree in Health Information Management required

• Current credentials as a Registered Health Information Administrator (RHIA), or a Registered Health Information Technician (RHIT) are required.

• CCS credential required.  

Work Experience: 

• 5 years’ experience in coding, edit resolution and denial mitigation for inpatient and outpatient records in a multi-specialty setting is required.

• Experience in troubleshooting applications used in coding operations preferred

Knowledge, Skills, and Abilities Required: 

• Knowledge of ICD-10-CM/PCS and CPT 4 coding

• Knowledge of anatomy and physiology, medical terminology and the various medical specialties as required to accurately code all different types of medical records. 

• Ability to effectively coordinate staff training and continuing education.

• Ability to work well independently

• Ability to problem- solve. 

• Excellent written and oral communication skills. 

• Knowledge of medical necessity guidelines and recognition of the impact on coding accuracy and appropriate hospital reimbursement

Physical Requirements: 

• Job requires computer literacy.

• Speech, sight and hearing required as incumbent must work independently in effectively training and monitoring coding functions.

• Long periods of sitting