Coding Audits - Silver Spring, United States - Children's National Hospital

Children's National Hospital Silver Spring, United States

12 hours ago

Description

The Supervisor of Coding Audits and Education supports the supervision, management, evaluation, and improvement of operations related to coding education, audits, and denials. Leads the Coding and Auditing team responsible for evaluating the appropriateness and medical necessity of services and procedures billed based on supporting documentation, as well as the appropriateness of ICD-10, HCPCS and CPT codes and modifiers. Oversees the review of clinical denials for technical and professional services. Provides strategic direction for the development of training materials for coders, physicians, clinical documentation specialists, and other healthcare personnel. Partners with vendors for external audits of coder and organization performance.

Qualifications:
Minimum Education
Associate's Degree or equivalent coding audit and education work experience (Required)

Minimum Work Experience
4 years 4 years of hospital auditing and coding experience. Pediatric experience preferred.. (Required)

Required Skills/Knowledge
Strong understanding of coding processes and their relation to the overall Revenue Cycle data flow/third party reimbursement
Knowledge of accepted medical abbreviations and their meanings
Knowledge in the use of specialized references such as the ICD-10-CM/PCS and CPT-4 books, medical dictionaries and medical journals
Proficiency with Microsoft Office product suite
Ability to communicate professionally with physicians, third party payers and other organization members about to coding principles and processes
3M and/or Cerner Millennium experience strongly preferred

Required Licenses and Certifications
CPC, CPC-H, CCS-P , or CCS .

Functional Accountabilities
Audits and Coding

Oversee routine retrospective and prospective professional and technical billing audits, specialized and focused audits, and other audits as directed by the Senior Manager
Oversee preparation of written reports of audit findings and recommendations to leadership and staff as appropriate.
Assist in risk assessments to define audit priorities by evaluating previous audit findings, management priorities, ICD and CPT code utilization patterns, national normative data, CMS and Medicaid initiatives, and healthcare industry best practices.
Maintain up-to-date knowledge of healthcare coding compliance requirements, practices and trends and ensure teams' compliance.
Maintain knowledge of current government and other third party payor coding and documentation requirements.
Oversee analysis of coding-related denials and lead efforts to resolve and learn from trends.
Assist in management of requests that come from Revenue Cycle teams related to coding questions on coding guidelines and denials, escalating as needed, and conducting appropriate research.
Analyze process improvement opportunities for auditing and coding teams to identify denial risks mid-cycle.

Education

Oversee professional and technical procedure and diagnosis coding education and training for coders, physicians, NPPs, clinical documentation specialists. and other healthcare personnel.
Oversee all activities related to the training programs, including curriculum development, job aids, testing methodology, software and delivery, exam development/delivery, employee competency metrics, certifications and development needs.
Assist in project management/leadership for all coding training programs as they are requested throughout the enterprise.
Determine Key Performance Indicators and create/analyze metrics to determine the impact of training initiatives and ensure goals are met.
Perform analysis of CNMC coding and productivity data against industry benchmarking standards as applicable.
Research coding guidelines when conflicts arise within current policies and procedures.
Research updated coding information as it becomes available annually and mid-year; summarize/share changes impacting Revenue Integrity staff members.

Communication

Role model expertise in communication through collaboration with the Director, Managers, physician and hospital management, and staff.
Work collaboratively with all Directors, Managers and Physicians to achieve optimal clinical code capture for appropriate SOI scores and DRG assignments.
Provide performance feedback in a constructive manner to staff.

Staff Development

Develop and implement systems to monitor performance and quality of audits and educational materials.
Develop and provide educational programs for auditors, denials analysts, and educators.
Coach, develop and encourage staff in designated areas of supervision.
Participate in human resource education programs including customer service, management and supervision and other industry-wide programs impacting health care.
Complete performance evaluations on all assigned staff in a timely manner.

Customer Service

Greet staff cordially and acknowledge positive productivity.
Actively participate in the resolution of challenges that impact negatively on the department.
Proactively demonstrate customer-oriented behavior and act as a role model for all staff.

Organizational Accountabilities
Organizational Accountabilities (Staff)
Organizational Commitment/Identification
Teamwork/Communication
Performance Improvement/Problem-solving
Cost Management/Financial Responsibility
Safety

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