Senior Coding Educator and Data Consultant

Scope of Position: The Senior Coding Education and Data Consultant ensures documentation and coding compliance at Ohio State University Wexner Medical Center. The Senior Coding Education and Data Consultant is responsible for conducting data analysis, generating and developing reports, auditing coding and medical record documentation, identifying improvement opportunities, and creating education plans for coders, CDIs, and providers. This role is expected to develop an action plan and influence adoption by effectively engaging coding, CDI, and providers.

The consultant evaluates performance to assess the quality of medical record documentation and coding, preparing recommendations based on the results. They monitor the case-mix index for services and hospital entities, Vizient and hospital-related quality initiatives (e.g., patient safety indicators, pressure ulcer monitoring, mortality reviews, etc.), and the Program for Evaluating Payment Patterns Electronic Report (PEPPER). These measures help identify opportunities for improvement and help ensure compliant coding. The consultant provides and presents detailed findings reports. The consultant will conduct in-depth reviews of billed codes, charges, and modifiers and report findings.

Moreover, the Senior Coding Education and Data Consultant serves as a subject matter expert on compliant documentation and coding opportunities. The Senior Coding Education and Data Consultant will guide root cause analysis, measure coding and reimbursement opportunities and risks, and then communicate these findings to the Director of Coding and Compliance, as requested by the Administration.

Position Summary : This position conducts health-system-wide coding analyses to promote compliance with federal and state regulations pertaining to but not limited to ICD-10-CM, ICD-10-PCS, and CPT-4 coding, assignment of modifiers, charge entry, and data abstraction for hospital billing and must understand the principles of physician documentation. Under the direction of the Director of Inpatient Coding and Compliance, the Senior Coding Education and Data Consultant assists in determining controls and monitors risk areas or changes to review risk management and ensure compliance with documentation and coding regulations. Consultant operates with extreme tact and diplomacy in performing job duties while interacting with faculty and staff from all areas of the Medical Center.

Duties and Responsibilities

75% of the time Hospital Quality Initiatives, Audits and Data Analysis

• Reviews mortality cases in accordance with hospital coding guidelines and completes audit abstract of data elements in Epic.
• Conducts and reviews coded accounts for other quality initiatives such as present on admission.
• Tracks hospital quality reviews and collaborates with clinicians.
• Routinely attends meetings with various Quality Department teams.
• Designs and runs reports from the Information Warehouse, Vizient database, or using other available databases, including but not limited to MedPar data. Develops reports to analyze codes assigned and billed.
• Coordinates and conducts audits to investigate reported variances in the coding between the hospital and professional claims or missing or inaccurate modifiers or charges. Prepares detailed reports of findings and recommends corrections to billed information.
• Works with Finance, Patient Financial Services, Compliance and Revenue Integrity staff, governmental and regulatory agencies to investigate and address alleged or reported coding and billing inaccuracies, analyze charges and codes, and promote compliance with all applicable coding and billing requirements.
• Analyzes information to determine areas of potential undercoding, miscoding, or upcoding.
• Analyzes information to identify missing or potentially inaccurate abstracted information, e.g., discharge disposition.
• Analyzes charge details to identify missing or potentially inaccurate charges.
• Analyzes case mix index to determine areas of opportunity. Benchmarks Wexner Medical Center's performance against comparable healthcare organizations.
• Presents with full understanding of reports, presentations, maps, and graphs, reflecting the collaboration of external and internal parties, summary, and translation of data into actionable information.
• Receives and interprets reports from regulatory agencies, i.e., CMSs Payment Error Prevention Program Report (PEPPER). Runs reports to compare the reports to our internal data. Analyzes cases to determine opportunities for improvement and reports findings with recommended corrective action.
• Develop reports to provide regular communications throughout the investigation process.
• Annually assists the Director in preparation for IPPS and OPPS.
• Ascertain patterns that require a change in policy and forward these issues to the Director of Coding and Compliance with suggestions to remedy the problem.
• Maintains detailed documentation of coding reviews, audits, and actions taken.

• Operates under minimal supervision while serving as a senior departmental resource.
• Supports the integrity of the coding and accurate reimbursement, quality scores, benchmark data, and statistical reporting.
• Always maintains patient confidentiality.
• Create and implement education resources regarding coding and documentation best practices to guide in anticipation of organizational needs and/or response to regulations and annual updates.
• Manage denial processing, working with various hospital departments and Provider offices. Assists with all aspects of the coding denial process, including appeal and collaboration with outside sources and internal resources to research and respond to various denial cases.
• Communicate with department staff, office staff, payors, providers, and third-party contractors to ensure all information is accounted for, appropriate, and timely.
• Attends rounds for patients on assigned services as appropriate. Meets with physicians and providers to review and discuss documentation improvement on patient records during or immediately following rounds.
• Relates the importance of complete documentation on coding quality, DRG assignment, physician profiling, and case mix index.
• Provide education on documentation requirements to residents, CNPs, and PAs when they join the service.
• Reviews specific case information, locates diagnostic and procedural information in the medical record, utilizes encoding software and determines working and possible DRG assignments, shares information with medical staff, and seeks clarification from physicians as necessary to refine coding assignments.
• Enters documentation review activities, including the working DRG in the IHIS CDI module per policy and other department requirements.
• Develop and present education programs to physicians and other clinical and administrative staff.
• Works collaboratively with interdisciplinary teams on documentation improvement initiatives, including physicians, nurse practitioners, physician assistants, and department managers in patient financial services, Utilization Management, and Medical Information Management.
• Develop clinical education programs for CDI and coding.

Required Qualifications :

A Bachelor's degree in Health Information Management or equivalent experience with extensive clinical knowledge and a minimum of 6 years of relevant experience is required. 8-12 years of relevant experience preferred, and one of the following certifications is required:

Accredited as a Registered Health Information Administrator (RHIA) or Registered Health Information Technician (RHIT), Certified Coding Specialist (CCS), Certified Documentation Improvement Professional (CDIP) by the American Health Information Management Association, or Certified Clinical Documentation Specialist (CCDS) by ACDIS.

Candidates with a Bachelors degree in Nursing will be considered in lieu of a Bachelors degree in Health Information Management and have a current RN license. A minimum of 6 years of relevant experience (with two (2) years of inpatient-based coding/CDI) is required. 8-12 years of relevant experience preferred.

Candidate should possess a broad knowledge of complex disease processes, preferably in an inpatient setting.

Knowledge of ICD-10-CM, ICD-10- PCS, Official Coding Guidelines, and Medicare Billing Rules is required.

Additionally, candidates must possess strong leadership skills, such as the ability to guide and motivate a team, and effective communication skills, including the ability to convey complex medical information to CDI, coding, and clinicians.

Candidate should demonstrate competency in the teaching/learning process, organizational skills, and computer literacy.

Excellent communication skills and a professional demeanor are required.

Preferred Qualifications:

Experience as an educator is preferred.

Experience with 3M encoder and reporting preferred.

Experience utilizing spreadsheets to gather, analyze, and report data.

Knowledge of hospital reimbursement models, trends, and their impact.

Being an effective educator, self-start, and highly organized is required.

The ability to exercise initiative and judgment is required.

Knowledge of medical terminology and anatomy.

Knowledge of Word, Excel, and PowerPoint is preferred.