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Coding Quality Coordinator

**Location:** Larkin Bldg @ Exchange Street

Location of Job: US:NY:Buffalo

Work Type: Full-Time

**Shift:** Shift 1

Job Description

Summary:

The Coding Quality Coordinator (CQC) professionals ensures accurate coding and data collection for reimbursement. They strive to promote an accurate and meaningful databases best represents resources used in patient care. The CQC acts as an essential resource working collaboratively with Coding Specialists, Physicians/Providers, Clinical Document Specialists, Quality Department, Nursing, Patient Management, Patient Financial Services, Corporate Compliance, Clinics, and Ancillary depts to perform and review the coding and DRG assignment for accuracy. Serves as the liaison between coding specialists and clinical documentation specialists for DRG Mismatch and reconciliation of case variation.

Ensures all inpatient and outpatient diagnoses, procedures and data collection accurately reflects the appropriate case mix index, severity of illness, expected risk of mortality, the complexity of patient care and use of resources. Ensures accurate data collection for the NYSDOH Statewide Planning and Cooperative System that is used for planning and financial rate setting. Plan and execute audits for the quality of coded data to best represent the case mix, the accurate Diagnosis Related Group (DRG) assignment, proper reimbursement and quality measure/metrics. Assists with the audit analysis, trending, and presentation of audit/review findings, potential issues and identifies opportunities for education.

Specific to Outpatient and Emergency Department coding arena, the CQC must ensure the appropriate CPT procedure coding, modifiers, Evaluation and Management (E&M) coding, and charges are correct. Ensures identification of trauma registry cases and compliance with applied charges.

Demonstrate a high proficiency of the coding systems, data collection, coding conventions and guidelines, clinical conditions, diagnosis and procedures. Utilize coding proficiency to plan and execute quality audits, perform data analysis, trending, presentation of audit/review findings, and identify opportunities and develop a training plan for the coding specialist. Participates in a variety of other departmental quality audits that may be used to support quality measures reporting. Reports results of coding audits, researches coding materials and recommends educational programs.

Assists in investigating insurance denials to identify necessary action, corrects claims based on denials and audits; and rebills using payor approved process.

Determines need for payor appeal and sends individualized appeal letters

Education And Credentials

Responsibilities:

AAS - Associate of Applied Science in Health Information Technology or Medical Record Technology required. Bachelor of Science in Health Information Management, Medical Record Administration, Nursing, Health care Administration or similar preferred. 3 years acute care facility coding. Reg Health Info Tech (RHIT) and Reg Health Info Admin (RHIA)required upon hire. Certified Coding Specialist (CCS) through AHIMA is preferred. **Candidates must take and successfully pass a Kaleida Health coding test.**

Experience

Other information:

3 Years extensive knowledge of coding classification systems to include but not limited to ICD10 and/or CPT coding, AP-DRG, APR-DRG, MS-DRG assignment in an acute care facility. Present on admission guidelines, secondary diagnoses classification for MCCs/CCs, MDCs, APR DRG grouper, SOI, and ROM scores, MS DRGs, E/M leveling required. 2 years of experience in Quality Assurance/Audit skill set with inpatient/or outpatient including Evaluation and Management coding/or Interventional Radiology required. 2 years of experience in Analytical thinking, problem solving, verbal and written communication. Ability to work independently and diligently meet deadlines required. 2 years of experience in Acquired Conditions, Patient Safety Indicators, and CMS Core Measures preferred. 2 years of experience with Microsoft Office (Excel, Word), Internet, Encoder, Grouping software and Federal, state, and private payer regulations and health care reform as it relates to changes in chart review preferred.

Working Conditions

Working conditions:

Essential:

* Weight Requirement - Sedentary (10 lbs)

Job Details

Department: KH Health Information Management

Standard Hours Bi-Weekly: 75.00

Weekend/Holiday Requirement: No

On Call Required: No

**With Rotation:** No

**Scheduled Work Hours:** 6:30a-2:30p; 7a-3p; 7:30a-3:30p; 8a-4p; 8:30a-4:30p; 9a-5p

Work Arrangement: Hybrid

Union Code: N00 - Non Union KH

Requisition ID#: 1762

Recruiter: Danielle Harwell

Grade: HR212

Pay Frequency: Bi-Weekly

**Salary Range:** $61,756.50 - $84,922.50

*Wage will be determined based on factors such as candidate's experience, qualifications, internal equity, and any applicable collective bargaining agreement.

_Kaleida Health’s mission is to advance the health of our community, and we believe our diversity, equity, and inclusion (DEI) strategic work is mission- critical for the good of our workforce and the community who need and depend on our care and services. We understand that racism and health inequities stand firmly in the way of advancing the health of our community, and Kaleida Health envisions DEI as the pursuit of equity and restorative justice for every person. We will exemplify courage and accountability through both the professing and practice of our core values for our friends, colleagues, and community. Kaleida Health is committed to creating a culture of equity and inclusion where diversity is valued and celebrated!_

**Position** Coding Quality Coordinator

**Location** US:NY:Buffalo | Health Information | Full-Time

**Req ID** null

Equal Opportunity Employer

Kaleida Health is committed to diversity and believes our workforce is strengthened by the inclusion of and respect for our differences.

Kaleida Health is an equal opportunity and affirmative action employer. All qualified individuals are encouraged to apply and will receive consideration without regard to race, color, religion, sex, national origin, citizenship status, creed, gender, gender identity or expression, sexual orientation, disability, veteran status or any other factor which cannot lawfully be used as a basis for an employment decision.

Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. Please tell us if you require a reasonable accommodation to apply for or perform your job.