Coding Coordinator

Review coded medical records for coding and DRG accuracy by verifying that the principal diagnosis, secondary diagnoses, principal procedure, secondary procedures and disposition have been assigned accurately and ensure the highest level of reimbursement to which the facility is legally entitled. This is completed according to established coding guidelines and rules for reporting and in adherence with the American Health Information Management Association Code of Ethics. All coding staff have quality audits performed on a consistent basis, the results of which are incorporated into their performance reviews.

Accountabilities

• Perform SMART audits and discharge disposition validation on 100% flagged records. Perform focused audits, as necessary. Investigate and correct SMART data validation report outliers. Utilize SMART reports for analysis or patterns/trends in coding problems/errors.
• Perform post discharge physician queries to assist in clarifying vague or unclear documentation. Keep data on query response rate.
• Refer coding classification and severity of illness assessment questions to management in a timely manner for determination and guideline development.
• Research, review and respond to coding and coding quality issues and questions from various internal and external departments.
• Perform audits of the assigned ICD-10-CM/PCS codes to insure that charts are coded by adhering to coding conventions and official coding guidelines with 98% accuracy. Perform audits of the assigned DRGs to insure accurate, optimal assignment with 98% accuracy. Simultaneously review the accuracy of all abstracted data to insure key elements are abstracted correctly.
• Perform second level death review for all APR SOI and ROM Scores below 4 and communicate summary of findings to the appropriate Physician Service.
• Coordinate internal/external compliance/DRG audits. Initiate corrective action to ensure resolution of problem areas identified during an internal investigation or auditing/monitoring activity. Respond to third party audit findings, as needed.
• Communicate with Patient Accounting on rebilling of accounts that need to be corrected (i.e. coding, disposition, DRGs). Communicate with co-workers, management, physicians, and other hospital staff regarding clinical documentation and reimbursement issues.
• Perform account completion activities, i.e., contacting CRM for disposition, answering coder questions, query completion, as needed, to positively impact DNFB.
• Work in conjunction with Coding Quality Specialists to ensure coding quality of coding staff. Provide training to new coding staff and cross-training to existing staff.
• Identify and communicate documentation issues and concerns that influence coding, DRG assignment, and severity of illness assessment to management, as identified.
• Summarize and report quality results and submit to management monthly.
• Performs duties in accordance with Penn Medicine and entity values, policies, and procedures
• Other duties as assigned to support the unit, department, entity, and health system organization

Minimum Requirements

Required Education and Experience

• Bachelor's Degree Health Information Management or related field.
• 5+ years Inpatient coding experience at a tertiary care facility, preferably in an academic medical center.

Licenses, Registrations, and Certifications

• RHIA or RHIT
• Certified Coding Specialist-CCS (AHIMA)

Required Skills and Abilities

• Extensive knowledge of medical terminology, human anatomy and physiology, and clinical disease processes
• Knowledge of federal, state, and third party payer requirements
• Extensive knowledge of ICD-10-CM/PCS classification systems
• Familiarity with computerized encoders

As part of our COVID-19 response, this position may currently be offering partial or full remote work. However, in the near future this position will require full or partial on-site work.