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Highmark Health Director Outpatient Clinical Documentation and Coding Integrity in Home, Kansas

Company :

Allegheny Health Network

Job Description :

GENERAL OVERVIEW:

This job will act as the liaison to clinical practices and providers by providing education and support to better understand ambulatory coding guidelines, regulatory/payer requirements and the relationship between documentation, the code assigned, and the effect on accuracy, compliance, quality initiatives and reimbursement.

ESSENTIAL RESPONSIBILITIES

  • Perform management responsibilities to include, but are not limited to: involved in hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity.Plan, organize, staff, direct and control the day-to-day operations of the department; develop and implement policies and programs as necessary; may have budgetary responsibility and authority. (20%)

  • Serves as a key resource for Institute Leaders, staff, physicians and administration to obtain information on accurate and ethical coding and documentation standards guidelines and regulatory requirements. (20%)

  • Establishes cooperative and multidisciplinary relationships with other teams including, but not limited to, Institute Leadership, Physicians, Compliance, Revenue Integrity, Coding, Billing, HIM, UR and Quality. (15%)

  • Effective ability and willingness to communicate benefits of complete and accurate documentation to physicians related to their daily practice of medicine. (15%)

  • Analyzes and compiles accurate and complete data to identify trends and/or opportunities, develop strategies, targeted education and potential solutions for improvement. (15%)

  • Develops, implements and maintains formal and informal educational programs related to documentation improvement opportunities, coding and reimbursement issues, as well as performance improvement methodologies for internal customers and physicians. (15%)

  • Other related duties as required.

QUALIFICATIONS:

Minimum

  • Associates Degree in Health Information, Nursing, or related field OR RN License with 6 years of nursing experience

  • 5 years in Bedside Nursing

  • 5 years in HIM / Coding with superior knowledge of documentation

Preferred

  • Bachelor's Degree in Nursing

  • Current RN License

  • Certified Coding Associate (CCS) OR Registered Health Information Technician (RHIT) OR Registered Health Information Associate (RHIA) OR Certified Outpatient Coder (COC) OR Certified Professional Coder (CPC)

  • Certified Clinical Documentation Specialist (CCDS) OR Certified Clinical Documentation Specialist-Outpatient (CCDS-O)

  • Knowledge and expertise of outpatient coding guidelines and HCC coding requirements.

  • Ability to translate communication between Coding and Providers

  • Strong IT skills, organizational skills, analytics, and ability to present data and findings in a meaningful way to the audience

  • Ability to understand and interpret payor policy along with Revenue Cyce workflows and requirements.

  • Strong knowledge around OPPS, modifier requirements, OCE edits, and Medical Necessity policies

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement : This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy.

Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, age, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.

EEO is The Law

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For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org

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Req ID: J191172

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