SHSMD Career Center
Gainesville, Florida
Durham, North Carolina
New York, New York
Posted: 04-Sep-23
Location: Durham, North Carolina
Salary: Open
Categories:
Internal Number: 235309
Duties and Responsibilities of this Level:
A. Monitor data quality and optimal reimbursement to the hospital by performing concurrent and prospective quality reviews for accurate coding and sequencingCD-10-CM diagnoses and ICD-10-PCS or CPT-4 procedures (and appropriate use of modifiers) for inpatient and outpatient services using Center for Medicare and Medicaid coding guidelines, standards and regulations.
- 35% of time spent
- Interpret guidelines, applicable laws, and regulations concerning hospital coding published in AHA Coding Clinic, AMA CPT Assistant, Federal Register, Medicare Bulletin, etc. Develop and maintain specific coding guidelines for inpatient and outpatient coding. Research problem areas and develop training material and coding aids for the coders.
- Present timely, relevant educational programs to coding staff regarding coding updates, documentation, and prospective payment system requirements. Participate in the training of the coders and evaluate the effectiveness of the training.
- Maintain/update the coding compliance manual.
- Monthly report on findings to coding staff and others (including the Compliance Department).
B. Identify coding and billing risk areas for the hospital technical charges, conduct focused reviews, report the results, and implement corrective action as needed.
- 30% of time spent
- Serves as the technical expert for questions
- Conduct routine internal audits of coded data and physician documentation, report the results, and recommend corrective action as needed
- Respond promptly to external audits and implement corrective action as appropriate.
C. Serve as a resource to the hospital on coding and documentation-related issues. Educate physicians and other healthcare professionals regarding documentation requirements for accurate coding and reimbursement. Educate administration, Financial Management, Patient Resource Management, Revenue Managers, etc. regarding DRGs/APCs/APR-DRGs and the reimbursement methodologies.
- 30% of time spent
- Collaborates with HB Coding, Billing, and others for process or system changes.
- Participates in the creation and execution of educational initiatives associated with HIM strategies
- Effectively communicates verbally and in written form, including the provision of updates to the Associate Director and Director regarding the operation of the work unit, project status, and staff issues
D. Other - 5% of time spent
- Performs other related duties incidental to the work described herein and performs other related work as required
Minimum Qualifications
Education
Work requires organization, analytical, and communication skills program. generally acquired through the completion of a Bachelor's degree
Experience
Four years of administrative experience to acquire competence in applying compliance, coding, and auditing principles as they relate to insurance billing, collections, consulting, and other revenue cycle-related functions. For technical coding, two of the four years of experience with DRGs and APR-DRGs is required. Experience in formal teaching of coding is preferred. RHIA or RHIT or CCS required. For professional coding, specialty coding experience in surgical or E/M coding is preferred. CPC or CCS or RHIT or RHIA or CPMA is required.
Duke is an Affirmative Action/Equal Opportunity Employer committed to providing employment opportunity without regard to an individual's age, color, disability, gender, gender expression, gender identity, genetic information, national origin, race, religion, sex, sexual orientation, or veteran status.
Duke aspires to create a community built on collaboration, innovation, creativity, and belonging. Our collective success depends on the robust exchange of ideas-an exchange that is best when the rich diversity of our perspectives, backgrounds, and experiences flourishes. To achieve this exchange, it is essential that all members of the community feel secure and welcome, that the contributions of all individuals are respected, and that all voices are heard. All members of our community have a responsibility to uphold these values.
Essential Physical Job Functions: Certain jobs at Duke University and Duke University Health System may include essentialjob functions that require specific physical and/or mental abilities. Additional information and provision for requests for reasonable accommodation will be provided by each hiring department.
