Coding Integrity Specialist

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A Brief Overview
The Coding Integrity Specialist is responsible for reviewing and resolving coding denials. This position analyzes, codes, and assigns ICD-10-CM/PCS and CPT codes to specialty services such as Behavioral Health, Cardiology, Interventional Radiology, Recurring Accounts, and other accounts as needed.

What you will do

• 1. Responsible for coding specialty services.
• Ensures records are processed timely.
• Assign codes based on documentation contained in the medical records. Only accurate and appropriate documented services are coded.
• Should be able to code inpatient, outpatient surgery, and outpatient clinics with an accuracy rate of 95% or greater.
• Assures the accuracy, integrity, and consistency of coded data.
• Utilizes and demonstrates the skill and knowledge to effectively communicate with hospital personnel, including, but not limited to, physicians, nurses, administrators, directors, and co-workers.
• Provide coding education and support to providers.
• Work with ancillary and other departments to ensure proper utilization of the chargemaster. Review charging practices to ensure appropriate charge protocols are followed and supporting documentation is acceptable and in order.
• Assists Business Office and Revenue Cycle Team with technical expertise for coding questions related to denied claims or charge questions.
• Prepares formal reports and makes formal presentations on assessment findings.
• Assists with other projects and assignments as necessary.
• Strict adherence to AHA Coding Clinic, CPT Assistant, CMS Official Guidelines for Coding and Reporting, and approved ICD-10-CM/PCS coding guidelines.
• Strict adherence to AHIMA's Standards of Ethical Coding.
• Stay current with coding updates and changes.
• Performs other duties as assigned.
• 2. Maintain productivity standards:
• Behavioral Health Inpatient records -3 per hour
• Behavioral Health Outpatient records - 8 per hour
• Cardiology records - 2 per hour
• Interventional Radiology - 5 per hour
• Epic Simple Visit Coding reviews - 6 per hour
• Recurring Accounts - 4.5 per hour
• 3. Identify and resolve Epic Simple Visit coding issues.
• 4. Track and report Epic SVC coding discrepancies.
• 5. Utilize the Epic EHR and HDM/3M coding system to code and submit records to billing.
• 6. Knowledge and proficiency in healthcare and information systems standards through various Standard Development Organizations such as Health Level 7, those recommended by The Interoperability Standards Advisory, and alignment with current standards.
• 7. Working knowledge of documentation, charting, and billing and ability to abstract health
• 8. Ability to create a high degree of trust between oneself and the various application users and the capability to act as the interface between these user communities
• 9. Strong analytical and organizational skills
• 10. Must be able to work independently
• 11. Will be required to manage complex projects simultaneously
• 12. Must be detail, action, solution, and results-oriented
• 13. Computer skills essential; at a minimum, the ability to use the MS Office suite of applications
• 14. Have analytical and business knowledge to determine the impact of requested changes and to understand the reasons behind requests thoroughly
• 15. Exhibit excellent analytical skills, the ability to oversee multiple projects under strict timelines, as well as the ability to work well in a demanding, dynamic environment and meet overall objectives
• 16. Critical thinking skills are a must.
• 17. Ability to adapt to changes in workload and work functions and to effectively prioritize work assignments.
• 18. Work collaboratively with other hospital personnel to resolve charging challenges.

Education Qualifications

• High School Diploma / GED Required
• Associate's Degree Registered Health Information Technology Preferred
• Bachelor's Degree Registered Health Information Administrator Preferred

Experience Qualifications

• At least four (4) years A minimum of 4 years inpatient and outpatient coding experience Required

Skills and Abilities

• Knowledge of Microsoft Office software, MS Outlook, and EMR applications
  (Required proficiency)

Licenses and Certifications

• Certified Coding Specialist (CCS) - American Health Information Management Association (AHIMA) - within 12 months - Required or
• Certified Coding Specialist-Physician-Based (CCS-P) - American Health Information Management Association (AHIMA) - within 12 months - Required or
• Certified Professional Coder (CPC) - American Academy of Professional Coders (AAPC) - within 12 months - Required

To carry out its mission, CHOP is committed to supporting the health of our patients, families, workforce, and global community. As a condition of employment, CHOP employees who work in patient care buildings or who have patient facing responsibilities must be fully vaccinated against COVID-19 and receive an annual influenza vaccine. Learn more.

Employees may request exemptions for valid religious and medical reasons. Start dates may be delayed until candidates are immunized or exemption requests are reviewed.

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