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Job: HB Coding Analyst and Educator
Classification: Salaried/Exempt
Job Category: 2 - Professional
Position Summary:
The HB Coding Analyst and Educator at TRMC plays a critical role in ensuring compliant, accurate coding practices while fostering continuous education and collaboration between physicians, providers, clinical staff, hospital departments and coding staff. The role requires expertise in hospital-based physician services coding, analytical skills to assess coding accuracy, and the ability to develop and deliver educational programs. The Analyst is responsible for reviewing coded hospital accounts, identifying improvements, and ensuring synergy between clinical documentation, coding, and providers. The analyst would assist with enhancing clinical workflows including input regarding EPIC templates.
Essential Functions:
-Conducts comprehensive reviews of hospital billing (HB) coded accounts (inpatient/outpatient) to evaluate the accuracy and completeness of assigned ICD-10-CM, CPT/HCPCS, and modifiers based on physician documentation and medical records.
-Audits medical records to evaluate provider and coder performance. Additionally, identify errors, inconsistencies, and missed opportunities for capturing additional diagnoses and procedures.
-Analyzes trends in coding practices and identify areas needing improvement or further education. Partners with coders, departments and providers to make improvements in overall performance, quality, and accuracy.
-Collaborates with clinicians and coders to resolve discrepancies and ensure accurate code application.
-Identifies knowledge gaps and specific training needs through charging and coding analysis findings and by pulling information from industry resources such as AAPC, AHIMA, and CMS guidelines.
-Designs curriculum materials addressing current coding guidelines, industry best practices, and emerging trends in healthcare coding and documentation. Determine which resources are needed to apply knowledge (tip sheets, workflows, policies, work queues, process documents, etc).
-Utilizes a variety of teaching methods, including in-person and online sessions, interactive workshops, and e-learning modules, catering to different learning styles and professional levels.
-Delivers engaging and informative training sessions aimed at enhancing coding accuracy, efficiency, and compliance.
-Monitors industry publications, websites, and participate in relevant coding associations to stay informed of updates in coding regulations and guidelines.
-Analyzes the impact of new hospital coding rules and regulations on internal practices and incorporate these changes into training and coding procedures by ensuring quarterly and annual code updates are implemented and educated on.
-Ensures that both coding systems and staff remain updated on coding changes, promoting compliance with CMS, other governing bodies, and payers.
-Stays abreast of regulatory updates and industry standards to ensure all practices are in line with federal and state guidelines, including adherence to CMS mandates.
-Analyzes internal and external data to identify trends, potential issues, and areas for improvement.
-Collaborates with TRMC IT and revenue cycle management teams to optimize coding, documentation, and CDM management systems.
-Manages technical upgrades, ensuring seamless implementation of new modules or system enhancements including provider templates.
-Must follow and adhere to TRMC's vaccine policy(s) as mandated by the Centers for Medicare & Medicaid Services (CMS).
Skills/Competencies:
-Strong knowledge of medical terminology, disease classification, and healthcare coding systems (ICD-10-CM, ICD-10-PCS, DRG, CPT, HCPCS).
-Proficiency with healthcare coding software, including CAC and EPIC.
-Strong analytical and problem-solving skills.
-Excellent communication and interpersonal skills to foster collaboration across teams.
-Knowledge of CMS regulations and industry-based standards.
-Strong presentation and facilitation skills.
Work Experience:
- Minimum 3 years of experience in coding in a hospital setting, with experience in coding analysis or auditing preferred.
-Extensive knowledge of ICD-10-CM, CPT, and HCPCS coding guidelines and conventions.
-Demonstrated experience in developing and delivering educational programs for healthcare professionals.
-Knowledge of 3M and EPIC systems.
-Experience conducting audits and implementing quality assurance initiatives.
Education & Certifications:
-Associate's degree in Health Information Management, medical coding, or a related field, Bachelor's/Master's degree preferred.
-Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Outpatient Coder (COC), Certified Coding Specialist (CCS), or equivalent certification (required).
-Additional coding certifications from AHIMA or AAPC are a plus including CIC.
-EPIC Certification such as Resolute HB Charging (including CDM) is a plus.
Physical Demands and Work Environment
Lifting/Carrying Pushing/Pulling
Lbs. % Time Lbs. % Time
1-10 34-66 1-10 34-66
11-20 0-33 11-20 0-33
21-50 0-33 21-50 0-33
51-75 0-33 51-75 0-33
76-100 None 76-100 None
Movement % Time
Bend/Stoop/Twist 0-33
Crouch/Squat 0-33
Kneel/Crawl 0-33
Reach above Shoulder 0-33
Reach below Shoulder 0-33
Repetitive Arm None
Repetitive Hand 0-33
Grasping 0-33
Squeezing 0-33
Climb Stairs None
Walking Uneven 0-33
Walking Even 0-33
Environment % Time
Indoors 67-100
Outdoors 0-33
Extreme Heat None
Dusty None
Excessive Noise 0-33
Equipment % Time
Motor Vehicles None
Foot Pedals None
Extreme Heat None
Dusty None
Excessive Noise 0-33
Work near % Time
Machinery None
Electricity None
Sharps 0-33
Chemicals 0-33
Fumes 0-33
Heights None
Vision
Depth Perception Required
< 20" Required
Color Not Required
Peripheral Required
Endurance Hours at Once Total in 12HR
Sit 6 6
Stand 1 3
Walk 1 3