Coding Quality Specialist I - Coding

CHRISTUS Health; Irving (TX); On-site; USD 75,000 - 95,000; Full time

Job summary

CHRISTUS Health is seeking a Coding Quality Specialist reporting to the HIM Coding Education Manager to conduct internal coding reviews and support coding education across inpatient and outpatient settings. The role emphasizes maintaining 95% accuracy in ICD-10-CM/PCS and CPT/HCPCS coding, with collaboration across departments to provide training and improve documentation and coding practices.

The position requires five years of inpatient/outpatient HB coding experience, relevant AHIMA or AAPC

Qualifications

• High school diploma or equivalent years of experience required.
• Completion of AHIMA or related accredited program preferred.
• Five (5) or more years of inpatient/outpatient HB coding experience in acute care setting preferred.
• RHIA/RHIT, CCS/COC/CPC certifications required or preferred.

Responsibilities

• Facilitate inpatient and outpatient coding reviews.
• Communicate findings to support training and education initiatives.
• Develop review plans and education feedback for coding staff.
• Assist with annual education workplan for chart reviews and pre-bill reviews.
• Collaborate with Coding Integrity and other departments to develop job aids and best practices.
• Maintain an accuracy rate of 95% or higher.
• Work independently in a remote setting with minimal supervision.

Skills

ICD-10-CM/PCS knowledge

CPT/HCPCS knowledge

Education and training

Education

RHIA/RHIT certification

CCS/COC/CPC certification

AHIMA coding certificate

HI Informatics/HIIM degree preferred

Job description

Summary:

The Coding Quality Specialist reports to the HIM Coding Education Manager to perform internal departmental coding reviews in support of the Coding Operations Department’s business needs. This position contributes to coding education and training and facilitates pre-bill and cross-training to advance and keep current, the skillset of our inpatient and outpatient HB coding Associates.

The Coding Quality Specialist demonstrates high caliber specialty knowledge and understanding of current ICD-10-CM, ICD-10-PCS and/or CPT/HCPCS coding guidelines and practices in both the inpatient and outpatient care settings, maintaining a 95% accuracy rate.

Assignments are based on departmental needs and include but are not limited to PEPPER reviews, new hire and standard pre-bill reviews, remediation and performance improvement reviews and those required for corrective action plans, query quality and other focused reviews as may be needed. The Coding Quality Specialists will review for quality in regards to POA assignment, principal and secondary diagnosis code assignment, procedural coding, modifier usage, discharge disposition verification, query opportunities and DRG and APC accuracy.

Coding Quality Specialist will work collaboratively with various CHRISTUS Health Departments, including but not limited to the Regional Coding Managers, Coding Integrity, HIM, Compliance, and Clinical Documentation Specialist to ensure feedback is shared and reported for education and training purposes. The Coding Quality Specialist will also assist in production coding as may be required to keep current skills up-to-date and accustomed to changing technology and workflows.

The Coding Quality Specialist will report directly to the HIM Coding Education Manager, with additional leadership from the Director of Coding Operations and System HIM Director.

Responsibilities:

• Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders.


• Facilitate and complete inpatient and outpatient coding reviews.


• Communicates findings both verbally and in writing in an approved, appropriate format to support training and education such as would be reported in Coding Roundtables or Section Meetings.


• Assist with development and coordination of review plans, education and training feedback to coding staff that may include query opportunities, documentation opportunities, accurate code assignment (ICD, CPT, HCPCS), accurate payment groupings (DRG, APC), accurate modifier assignment, accurate POA assignment, accurate discharge disposition assignment, compliance and data management.


• Assist with chart sample selection for reviews and randomization to be coordinated with Coding Managers.


• Assist with finalizing an annual education workplan for targeted chart reviews and pre-bill reviews.


• Work collaboratively with Coding Integrity Department to recommend and assist with content and examples that may be used to develop Job Aides, Coding Best Practice references and other assisting resources to support and advance coder knowledge and expertise. Reviews results and performs trend analyses to identify patterns and variations in coding practices and/or case-mix index which require education.


• Meets or exceeds an accuracy rate of 95%.


• Ensure coding reviews are appropriate and effective. Assesses effectiveness through associate evaluations.


• Able to work independently in a remote setting, with minimal supervision.


• All other work duties as assigned by the Manager.

Job Requirements:

Education/Skills

• High school diploma or equivalent years of experience required.




• Completion of accredited Baccalaureate Health Informatics or Health Information Management or an AHIMA approved Coding Certificate Program, preferred.

Experience

• Five (5) or more years of Inpatient and/or Outpatient HB coding experience in an acute care setting preferred.

Licenses, Registrations, or Certifications

At least one of the following certifications are required:

• Registered Health Information Administrator (RHIA) (AHIMA)




• Registered Health Information Technician (RHIT) (AHIMA)




• Certified Coding Specialist (CCS) (AHIMA)




• Certified Outpatient Coder (COC) (AAPC)




• Certified Professional Coder (CPC) (AAPC)

Work Schedule:

8AM - 5PM Monday-Friday

Work Type:

Full Time