The CHRISTUS Health Coding Integrity Specialist is a system support position that provides acute care coding subject matter expertise, leadership, support, and direction, for the CHRISTUS Health System. The Coding Integrity Specialist will report directly to the Director of Coding Integrity.
The Coding Integrity Specialist will demonstrate high-quality knowledge and understanding of ICD-10-CM, ICD-10-PCS and/or CPT/HCPCS coding guidelines and practices for acute care reimbursement, while maintaining a 95% audit accuracy rate. The Coding Integrity Specialist will have a strong working knowledge of CHRISTUS Health applications in addition to other applicable software, required for auditing.
The Coding Integrity Specialist is responsible for supporting adherence to CHRISTUS standards, policies, procedures, guidelines, official coding guidelines, and other regulatory requirements including Centers for Medicare and Medicaid Services (CMS), the Joint Commission, and HIPAA standards related to HIM. The Coding Integrity Specialist will be responsible for obtaining external guidance as needed from Nosology, AHA, AMA, Z Health, and other recognized sources.
The Coding Integrity Specialist will receive work assignments based on business needs, including but not limited to retrospective reviews, focused reviews, pre-bill reviews, performance improvement reviews, query quality, coding related denials, and clinical documentation improvement opportunities. The Coding Integrity Specialist will audit for key quality metrics, including but not limited to, DRG Accuracy, POA assignment, principal and secondary diagnosis code assignment, procedural coding Accuracy, APC accuracy, modifier usage, discharge disposition, query opportunities, and abstracting accuracy.
The Coding Integrity Specialist will work collaboratively with various CHRISTUS Health teams, including but not limited to, Health Information Management, Coding Operations, Coding Managers, Coding Leads, Coders, Education, Clinical Documentation, Clinical Appeals, PFS, Corporate Compliance, Legal, Regional Leadership, and Revenue Integrity with a focus on Coding Integrity. Coding Integrity Specialists will also work collaborat9ively with external vendors and assist in other areas, as requested by leadership.
The Coding Integrity Specialist will complete coding audits, audit reports, statistical reports, rebuttals, and appeal correspondence in a format and venue that provides professional services and feedback. The Coding Integrity Specialist may assist with education and training for system, regional, or facility healthcare professionals on coding guidelines, practices, proper documentation techniques, medical terminology, and disease process.
- Must have and maintain at least one of the following:
- High school diploma or GED.
- Completion of accredited Baccalaureate Health Informatics or Health Information Management or an AHIMA approved Coding Certificate Program.
- RHIA Registered Health Information Administrator (AHIMA)
- RHIT (Registered Health Information Technician (AHIMA)),
- CCS (Certified Coding Specialist (AHIMA)
- Five (5) or more years of Inpatient and/or Outpatient coding experience in an acute care setting.
- Experience conducting training/educational sessions for professional staff including preparations of instructional materials.
- Experience with physician documentation audit experience.
- Experience performing and evaluating coding audits & quality performance required.
- Strong managerial, leadership, interpersonal skills; excellent written and oral communication and analytical skills are required.
- Strong written and verbal communication skills.
- Abel to work independently in a remote setting, with little supervision.
- Extensive knowledge of ICD-10-CM/PCS, CPT and HCPCS coding principles and guidelines and reimbursement systems - MS-DRG, APR-DRG and APC assignments.
- Must possess a general working knowledge in internal integrity requirements and procedures.
- Extensive knowledge of federal, state and payer specific regulations and policies pertaining to documentation, coding, privacy, and billing
- Excellent interpersonal and communication skills to deal with staff, co-workers, patients, and public.
- Adept at reading, writing, mathematics; multi-tasking; work well within stressful environment; have strong cognitive and problem--solving skills all with minimal supervision.
- Ability to create and interpret reports and provide guidance on studies and government regulations and guidelines related to HIM.
- Knowledge of information systems, healthcare applications, Microsoft applications, and database applications
C. Licenses, Registrations, or Certifications
- Registered Health Information Administrator (RHIA) (AHIMA)
- Registered Health Information Technician (RHIT) (AHIMA)
- Certified Coding Specialist (CCS) (AHIMA)