Job Description
The Coding Operations Subject Matter Expert (SME) is a Coding Professional who is a senior member of the Coding Operations Team who hold extensive knowledge of Coding/CCR operations, workflows, and Coding guidelines. Coding Operations SMES are skilled collaborators, communicators and problem solvers and are the are the front-line resource to their assigned project teams. The SME will collaborate with Coding Operations Home and Community Coding Managers, Leaders, and the Sr. Coding Educators to meet the needs of our customers with the goal of supporting the Learning and Development needs of assigned project teams. This role will support activities in General Operations/Projects, Education, and Quality/Compliance.
Day-to-Day and who they're working with?
- Really dependent on the time of the month.
- Internal monthly audits broken down by half-months to do and then deliver. First part of the month, they're working on the back half of the back month.
* 4 programs in the quality department -- monthly internal (our coders), India peer to peer (IPP) -- their auditors audit the India auditors, health plan project (HPP) -- run a report on the EMR on a health plan and determine what percentage they could audit based on the volume and audit those on a, HPA -- audit they receive from a health plan, their auditors have to go in and look at their results and rebut those if there was a mistake, lastly there is the new hire program and doing the precepting to get them to the accuracy level of the monthly. Monthly audit on all of the auditors (MTA) that Deb does and they're expected to reach 96% on the audits they have done (mixture of the 4-5 programs they have their hands in). Benchmark for this team is 30 audits/day and most of the time the team is higher than that. Currently has 2 people on her team doing this right now and they are very behind.
Accountabilities:
- Service Delivery -- Ensures an accurate, efficient, and effective and timely approach to daily activities supporting Clinical Coding Services.
- Customer Service -- Provides excellent customer service to all internal and external customers
- Liaison and Communication/Teamwork- Promotes a team environment and enhances partnership/Collaboration through effective communication ensuring an inclusive approach
Reports to: Coding Manager for Assigned Project with a dotted line to Associate Director of Learning and Development
Accountabilities:
- Service Delivery -- Ensures an accurate, efficient, and effective and timely approach to daily activities supporting Clinical Coding Services.
- Customer Service -- Provides excellent customer service to all internal and external customers
- Liaison and Communication/Teamwork- Promotes a team environment and enhances partnership/Collaboration through effective communication ensuring an inclusive approach
Responsibilities:
General Operations/Projects
- Provides expert level review of all assigned projects, identifies gaps, or trends and provides timely feedback to coding professional
- Audits ICD-CM codes, in accordance with Risk Adjustment documentation and coding standards and internal guidelines as set forth by project
- Supports and executes quality and Coder Education to include performance of focused quality audits
- Participates in Monthly Team Meetings, collaborating with Coding Manager and Coding Educator to provide feedback regarding gaps in education and trends in coding accuracy
- Collaborates with Business Analyst to ensure timely review of assigned quality reports for deficiencies
- Manages other processes and activities associated with projects as assigned by Coding Manager
Education
- Participates in onboarding including orientation of new hires to include precepting, feedback, and training as designated by Coding Manager
- Acts as a first line resource to assigned Coding Professional
- Collaborates with Coding Manager and Coding Educator in the review and updating of project internal guidelines
- Participates in the Coding Hotline
- Performs Quality Review for Query Compliance per project need identified by Coding Manager
- Participates in the Coding Operations Education Workgroup as an active member contributing recommendations for topics identified through trend analysis
- Participates in UAT testing for EMR Enhancements as needed
- Communicate critical information up the chain; speak up effectively on critical issues
Quality/Compliance
- Reviews work of others to ensure accuracy and compliance with protocols and workflow guidelines
- Participates in quality improvement projects and actions as assigned
- Participates in the review and communication of weekly quality assurance findings and recommendations including facilitating the rebuttal process workflow
- Reviews weekly findings for assigned project teams to identify trends and opportunities for Coding Education
Required Skills & Experience
Most Important:
- Coding Certification from AACP or AHIMA professional coding association -> specifically looking for CPC an CRC
- 5 years active coding experience with ICD diagnosis coding
- 3 years CMS HCC Coding Risk Adjustment Experience
- 2 years' experience in a coding auditor/educator or mentor role
- Requires strong knowledge of clinical conditions, procedures, and basic documentation requirements
- Requires strong verbal/written communication and interpersonal skills
- Must have the ability to perform in a deadline driven environment
- Must always maintain professionalism and a positive service attitude
- Ability to analyze facts and exercise sound judgment when arriving at conclusions
- Ability to effectively report deficiencies with a recommended solution in oral and/or written form
- Demonstrate Critical Thinking when making decisions
- Be an exemplar of the mission, values, culture, and philosophy of the enterprise
- Proficiency with Microsoft Office applications to include Word, Excel, PowerPoint and Outlook
Nice to Have Skills & Experience
- Certification as Certified Risk Adjustment Coder
- Experience or Certification as Clinical Documentation Improvement Specialist
Benefit packages for this role will start on the 31st day of employment and include medical, dental, and vision insurance, as well as HSA, FSA, and DCFSA account options, and 401k retirement account access with employer matching. Employees in this role are also entitled to paid sick leave and/or other paid time off as provided by applicable law.