OCCUPATIONAL SUMMARY
Under the supervision of the HIS OP Coding Reimbursement/Coordinator, coordinates day to day coding activities. Daily monitors the QuadraMed Compliance software system to ensure coding edits are completed in an accurate and timely manner for billing purposes. Works with respective departments to obtain medical record documentation for coding. Assists the OP HIS Coding Reimbursement/Coordinator in monitoring data for coding compliance and ensuring suspense levels within accepted turn around times. Communicates as needed with Lexicode to monitor OP daily unbilled.
PRIMARY DUTIES AND RESPONSIBILITIES
1. Audits OP accounts including Business Office account hold list, release list and follow up
2. Assists with AHRQ review as necessary
3. Provides Lexicode with daily reports: D/C lists, Completed Abstract reports and Suspense.
4. Communicates with clinical departments regarding insufficient documentation on individual accounts
5. Assists with Physician Query Process
6. Assists with Case Management IP only requests as necessary
7. Assists with Decision Support request as necessary
8. Assists OP HIS Coding Reimbursement/Coordinator as needed in monitoring coding compliance and appropriate clinical documentation on a case by case basis.
9. Assists OP HIS Coding Reimbursement/Coordinator as needed in monitoring coding compliance and appropriate clinical documentation on a case by case basis including infusion therapy coding, outpatient surgery/GI procedure diagnosis and procedure coding.
10. Serves as liaison for various internal and external coding reviews, assists with chart location, and investigates missing medical records and documentation
11. Prepares monthly data for compliance, productivity and quality reporting.
12. Communicate one on one with Lexicode to maintain OP unbilled at established levels
13. Works daily with Lexicode to resolve Northside Hospital issues to code individual records i.e., chart location, double numbers.
14. Participates in educational programs and in-service meetings.
15. Attends meetings as required
16. Performs other related duties as identified.
18. Works with Business Office program including: Pending, CCI, LMRP, ESA, and Medicaid Precert program.