Overview:
We are seeking a Coding Quality Analyst to join our team at UnityPoint Health! This role will conduct coding quality reviews of System Services coding for hospital based (HB) and professional (PB) coding services. The Analyst will evaluate coding for accuracy, completeness and consistency with internal policies and procedures, official coding guidelines, and regulatory guidance. Finally this role is responsible for communicating findings, recommendations and education to coders and management in a professional and timely manner.
Hours: Monday-Friday, standard business hours
Location: Remote - applicants must reside within the UnityPoint Health footprint of Iowa, Illinois or Wisconsin
Why UnityPoint Health?:
At UnityPoint Health, you matter. We’re proud to be recognized as a Top 150 Place to Work in Healthcare by Becker's Healthcare several years in a row for our commitment to our team members.
Our competitive Total Rewards program offers benefits options that align with your needs and priorities, no matter what life stage you’re in. Here are just a few:
- Expect paid time off, parental leave, 401K matching and an employee recognition program.
- Dental and health insurance, paid holidays, short and long-term disability and more. We even offer pet insurance for your four-legged family members.
- Early access to earned wages with Daily Pay, tuition reimbursement to help further your career and adoption assistance to help you grow your family.
With a collective goal to champion a culture of belonging where everyone feels valued and respected, we honor the ways people are unique and embrace what brings us together.
And, we believe equipping you with support and development opportunities is a vital part of delivering an exceptional employment experience.
Find a fulfilling career and make a difference with UnityPoint Health.
Responsibilities:
Coding Quality Review:
- Perform ongoing internal coding quality reviews to ensure coding is compliant and accurate for proper reporting and reimbursement
- Utilize basic quality review skills as specified by UPH Coding Quality policies
- Evaluate accuracy and sequencing of ICD-10 CM / PCS, CPT, HCPC codes including E/M level assignments for providers for a variety of patient types which may include, inpatient, outpatient, ambulatory, emergency room and physician clinic records for proper coding, billing and reimbursement
- Validate code(s), modifier(s), or MS-DRG/APC assignment for consistency with internal policies and procedures, regulatory guidance, and official coding guidance (i.e., AHA’s Coding Clinic, the Official Guidelines for Coding and
- Reporting or CPT); depending on the clinical setting or service line reviewed
- Validate diagnosis and procedure codes assigned are adequately supported by documentation in the medical record
- Reviews Coding and DRG denials in a timely manner and work with HIM, PFS, and clinical documentation integrity staff, as necessary. Educates Coding and CDI staff on identified issues and writes appeal letters as appropriate following official coding guidelines
- Adhere to AHIMA’s (American Health Information Management Association) Standards of Ethical Coding
- Provides quality checks of internal documentation and coding analysts, as applicable
- Perform quality reviews hospital acquired conditions (HACs) complications, patient safety indicators (PSI), and Program for Evaluation Payment Patterns Electronic Report (PEPPER)
- Reviews DRG mismatches for CDI and Coding
- Regularly research and utilize outside resources to maintain and update knowledge of coding requirements, documentation and best practices
- Provides continuing education activities and updates for coding staff, CDI staff and providers as required
- Assess clinical documentation, coding and billing practices for compliance with regulations of federal and state agencies and third-party payers; develop sound conclusions supported by audit evidence; identify opportunities to improve compliance and operating efficiency
- Work collaboratively with UPH management to best improve staff education, compliance, and controls related to coding, billing and other regulatory issues
Projects:
- Perform special quality reviews, as assigned
- Serve as a resource for coding questions and compliance issues providing guidance and expertise in the interpretation of, and adherence to, the rules and regulations for documentation and coding
- Respond to conduct clinical documentation integrity coding questions
- Maintains productivity expectations
- Maintains quality scores at or above 95%
- Attends meetings as directed by UPH management
- Performs other duties as assigned
Qualifications:
Education:
- Required: Completion of nationally recognized Coding Program (AHIMA/AAPC)
- Preferred: Two-year Health Information Technology Program
Experience:
- Required: At least 4 years of progressive on-the-job experience in an acute care or clinic setting
- Preferred: Trained in ICD-10-CM/PCS
- Preferred: Experience in auditing and/or clinical chart reviews.
Licenses:
- Required: Certified Coding Specialist (CCS), Certified Coding Specialist -Physician Based (CCS-P) Certified Professional Coder (COC/CPC), Certified Inpatient Coder (CIC), Certified Professional Coder – Hospital Outpatient (CPC-H)
- Preferred: Registered Health Information Technician (RHIT) or Registered Health Information Administrator (RHIA)