JOB SUMMARY Works in conjunction with physicians, case management, utilization review, compliance, Health Information Systems and other health team members to provide for comprehensive medical record documentation to reflect clinical treatment, decisions, and diagnosis for both inpatients and outpatients.

REPRESENTATIVE DUTIES Utilizes coding and clinical expertise to identify opportunities and ensure the completeness of clinical documentation used for measuring and reporting physician and hospital outcomes.

Conducts timely follow-up reviews of clinical documentation to ensure that issues discussed and clarified with the physician are documented in the patient’s chart.

Reviews clinical issues as needed with the coding staff to assign a working DRG.  Stays current with, develops, and conducts ongoing education for physicians, and allied health professionals.

Queries physicians on a concurrent basis to ensure that documentation appears in the medical record prior to coding and billing.  Works with physicians in the outpatient setting to identify missed opportunities related to clinical documentation and coding guidelines.

Is a member of the Clinical Coding and Documentation Improvement Team Workgroup that drives continuous improvement and supports revenue cycle processes and regulatory requirements.

Assumes accountability for achieving program objectives.  Completes trend analyses and reports findings to the revenue cycle management team.

Performs other duties as assigned.

Required Skills

Knowledge of medical terminology and abbreviations; anatomy and physiology; major disease process and pharmacology. Knowledge of classification systems CPT-4, E&M, ICD-9-CM, and HCPCS nomenclature, coding rules and guidelines. Knowledge of coding conventions and rules established by the American Medical Association (AMA), the Center for Medicare and Medicaid (CMS), AHIMA, and AAPC for assignment of diagnostic and procedural codes. Knowledge of the Privacy Act of 1974 and HIPAA Privacy Rule Act of 1996. Knowledge of coding software. Knowledge of auditing principles and standards. Knowledge of DRG payer issues and documentation.

Skill in developing and conducting training/educational sessions for diverse audiences. Skill in effectively managing and leading staff, and delegating tasks and authority. Skill in assessing and prioritizing multiple tasks, projects and demands. Skill in reading medical records, and finding and resolving documentation discrepancies. Skill in understanding medical billing procedures and protocols. Skill in judgment in applying appropriate codes to diagnosis, procedures, evaluation and management, and supplies. Skill in operating a personal computer utilizing a variety of software applications. Skill in operating a computerized medical coding and information processing systems. Skill in oral communication and presenting information to providers. Skill in writing technical reports and other materials for presentation. Skill in receiving, disseminating information, effectively and appropriately. Skill in using analytical and research skills to define and solve problems. Skill in assessing and prioritizing multiple tasks, projects and demands and effective project management. Skill in interpreting and applying ethical coding standards, federal and state laws and regulations; rules; policies and procedures; and professional practice standards for health care organization coding compliance program activities. Skill in medical record auditing and results reporting. Skill in working with physicians and health care teams.

Required Experience

MINIMUM EDUCATION QUALIFICATION A Bachelor’s degree in a health related field.  Progressively responsible professional work-related experience, education, or training may be substituted on a year-for-year basis for college education.

MINIMUM EXPERIENCE QUALIFICATION Non-Supervisory - Five (5) years experience in acute care environment.  An equivalent combination of relevant education and/or training may be substituted for experience.

MINIMUM CERTIFICATION/LICENSURE QUALIFICATION Must possess one of more of the following current state certifications/licensures: registered nurse, vocational nurse, coding DRG specialist, registered health information administration, or registered health information technology.

MINIMUM PHYSICAL REQUIREMENTS The following demands are representative of those that must be met by an employee to successfully perform the essential functions of this job.  Position requires the ability to sit, stand, and lift approximately 20 pounds.  ANMC is not a latex free environment. Therefore, some latex exposure can be expected.

Knowledge of medical terminology and abbreviations; anatomy and physiology; major disease process and pharmacology. Knowledge of classification systems CPT-4, E&M, ICD-9-CM, and HCPCS nomenclature, coding rules and guidelines. Knowledge of coding conventions and rules established by the American Medical Association (AMA), the Center for Medicare and Medicaid (CMS), AHIMA, and AAPC for assignment of diagnostic and procedural codes. Knowledge of the Privacy Act of 1974 and HIPAA Privacy Rule Act of 1996. Knowledge of coding software. Knowledge of auditing principles and standards. Knowledge of DRG payer issues and documentation.

Skill in developing and conducting training/educational sessions for diverse audiences. Skill in effectively managing and leading staff, and delegating tasks and authority. Skill in assessing and prioritizing multiple tasks, projects and demands. Skill in reading medical records, and finding and resolving documentation discrepancies. Skill in understanding medical billing procedures and protocols. Skill in judgment in applying appropriate codes to diagnosis, procedures, evaluation and management, and supplies. Skill in operating a personal computer utilizing a variety of software applications. Skill in operating a computerized medical coding and information processing systems. Skill in oral communication and presenting information to providers. Skill in writing technical reports and other materials for presentation. Skill in receiving, disseminating information, effectively and appropriately. Skill in using analytical and research skills to define and solve problems. Skill in assessing and prioritizing multiple tasks, projects and demands and effective project management. Skill in interpreting and applying ethical coding standards, federal and state laws and regulations; rules; policies and procedures; and professional practice standards for health care organization coding compliance program activities. Skill in medical record auditing and results reporting. Skill in working with physicians and health care teams.