Documentation & Risk Coding Analyst – Hospital Based

Major Responsibilities:

• Demonstrates full understanding and is compliant with regulatory requirements regarding coding of medical information including but not limited to external regulatory agencies such as Quality Improvement Organizations (QIOs), the Centers for Medicare & Medicaid Services (CMS), Medicare National Correct Coding Initiative edits and other payers.

• Partners with Coding, CDI, CMD and Quality professionals and others to advance documentation improvement practices.

• Exhibits and promotes a professional team-oriented service culture to achieve intended outcomes.

• Reviews clinical documentation and diagnostic results from the EHR to ensure appropriate assignment of the ICD-10-CM/PCS and/or ICD-10-CM CPT/HCPCS codes to support organizational and Clinician Services initiatives.

• As indicated, queries providers when existing documentation is unclear or ambiguous following established organizational policy.

• Partner within sub-function leadership and team members to identify opportunities for improvement based on analysis and review.

• Partners with Coding, CDI, CMD and Quality professionals, and others to advance documentation improvement practices.

• Exhibits and promotes a professional team-oriented service culture to achieve intended outcomes.

• Demonstrates positive collaboration with team members within Clinician Services and other organizational stakeholders.

• Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association (AHIMA), adheres to official coding guidelines as well as the organizational and departmental guidelines, policies and protocols.

• Demonstrates technical competence to use EHR, other software applications and official coding resources.

• Maintains confidentiality of patient records. Reports any perceived non-compliant practices to the Documentation and Risk leadership or compliance officer.

• Demonstrates continuous learning as evidenced by seeking educational opportunities, online publications etc., to stay abreast of new and revised guidelines, practices and terminology, for reference and application.

• Participate in on-site and/or external training workshops as opportunities arise. Maintains credentials, if applicable, and submits written evidence of maintenance.

Licensure, Registration, and/or Certification Required:

• Clinical or operational credential required. May include licensure as a clinically practicing professional (e.g., RN, RT, LCSW) or

• Certification in healthcare operations or project management (e.g., PMP, LSSGB, HFMA-CRCR).

• Certification in mid-revenue cycle operations from a recognized professional organization such as AHIMA, AAPC, or HFMA is required.

• Candidates without a certification in mid-revenue cycle from a recognized professional organization will be required to obtain one within 12 months of hire.

Education Required:

• Completion of advanced training through a recognized or accredited program, equivalent in scope and rigor to post-secondary education or equivalent knowledge.

• High school diploma or GED required

• Secondary specialty certification is preferred.

Experience Required:

• Minimum of 4 years of healthcare experience, including at least 2 years working as a clinician or in direct partnership with clinicians or recognized profession supporting clinicians (i.e. CDI, CMD or informatics), with demonstrated involvement in clinical documentation, coding, or documentation improvement initiatives.

Knowledge, Skills & Abilities Required:

• Extensive knowledge of third-party reimbursement programs, state and federal regulatory issues, national and local coverage determinants, research-related restrictions, ICD-10 CM/PCS, and CPT/HCPCS coding classifications.

• Demonstrated proficiency in Microsoft Office Suite (Word, Excel, PowerPoint, Teams, etc.) or similar products and in patient accounting and billing systems.

• Ability to deal and work effectively with multiple departments and in matrix organizational structures. Proven ability to influence others not directly reporting to them. Strong oral and written communication skills.

• Strong understanding of medical terminology, anatomy, and physiology to support precise code assignment.

• Highly proficient in problem-solving and strong attention to detail.

• Advanced knowledge of Epic.

Physical Requirements and Working Conditions:

• Follows organizational and divisional remote work policy and guidelines.

• Operates all equipment necessary to perform the job.

• Handles a fast paced and creative work environment moving independently from one task to another.

• Makes sound decisions within limited time frames and always conducts business in a professional manner and has demonstrates ability to work cooperatively and effectively with others on an individual and team basis.

• This position may require travel, therefore, will be exposed to weather and road conditions.

Education Preferred:

• Advanced training beyond High School that may include the completion of an accredited or approved program in Medical Coding and/or associate or bachelor’s degree preferred.

Licensure, Registration, and/or Certification Preferred:

• Second certification through AHIMA, CPC, or HFMA preferred.

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.

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