Behavioral Health Coding Coordinator

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A Brief Overview
The Hospital Coding Coordinator is critical in ensuring the accuracy, compliance, and efficiency of coding and billing practices for the enterprise. This position is responsible for supporting coding workflows, monitoring dashboards, monitoring and resolving denials, coordinating with teams, and supporting quality improvement initiatives. The Hospital Coding Coordinator will collaborate with departments to promptly resolve barriers to coding completion and denials. The ideal candidate will have a strong background in coding, regulatory compliance, and data analysis, with a proactive approach to problem-solving and process improvement. Knowledge of all DRG methodologies, Ambulatory Payment Classifications, ICD-10-CM/PCS, CPT-4, and HCPCS is needed.

What you will do

Coding Review & Resolution

• Responsible for resolving claims edit denials prior to billing.
• Review accounts not final billed to identify coding-related issues and determine appropriate resolution actions.
• Investigate and resolve coding denials in coordination with relevant departments.
• Review accounts flagged by coding systems or other departments for accuracy and compliance.
• Apply and adhere to hospital and external coding guidelines and regulations.
• Conduct research to resolve complex coding issues.
• Conduct research to resolve complex coding issues.

Analytical Reporting and Communication

• Track and trend barriers to clean claim submission.
• Identify and communicate coding issues and trends to the Coding Manager.
• Recommend areas for education and process improvement.
• Maintain established accuracy and productivity benchmarks.
• Identify non-compliant coding, documentation, and billing practices.
• Provide comparative benchmark reports for individuals and teams.
• Summarize findings for leadership reports and presentations.

Departmental Support & Collaboration

• Oversee coding denial and edit work-queues for aging accounts and claims errors.
• Collaborate with other departments to resolve coding and billing issues.
• Support initiatives to improve coding, documentation, and billing for optimal reimbursement and data capture.

Leadership

• Act as a team leader for complex projects.
• Oversee the timely completion of all denials.
• Act as a resource for the coding edit and denials resolution teams.

Audit & Compliance

• Conduct secondary quality checks on staff that perform coding edit review and coding denials resolution.
• Monitor denial trends for compliance-related root causes to compile and report the findings on a regular basis.

Training & Documentation

• Develop and maintain standardized orientation training for coding and documentation.
• Track training completion metrics and escalate unmet training needs.
• Create enterprise documentation tip-sheets in collaboration with other stakeholders.
• Track recurring deficiencies and recommend EMR template updates.

Regulatory Knowledge & System Support

• Maintain up-to-date knowledge of coding guidelines, payer policies, HIPAA, CMS, Medicaid, CPT Assist, and CPT-4.
• Apply and adhere to all CHOP coding guidelines and regulatory requirements.
• Maintain proficiency in medical terminology, coding structures, and emerging treatments.
• Assist with and support system/application maintenance and updates.
• Champion automation initiatives such as audit dashboards, work-queue design, and report auto-distribution.
• 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.

Education Qualifications

• High School Diploma / GED Required
• Associate's Degree Health Information Management or related field Preferred

Experience Qualifications

• At least three (3) years coding experience Required
• At least two (2) years experience in coding denials management, auditing, and compliance highly Preferred

Skills and Abilities

• Ability to lead a team for projects. (Required proficiency)
• Advanced knowledge of complex surgical coding. (Required proficiency)
• Advanced knowledge of ICD-10-CM and ICD-10-PCS. (Required proficiency)
• Advance knowledge of the APR-DRG system. (Required proficiency)
• Knowledge of the MS-DRG system. (Required proficiency)
• Knowledge the revenue cycle functions. (Required proficiency)
• Experience with encoder software such as 3M CRS and/or 3M 360 CAC. (Required proficiency)
• Familiarity with electronic health records (EHR), preferably Epic experience. (Required proficiency)
• Proficiency with Microsoft Office products such as Microsoft Office and Excel. (Required proficiency)
• Excellent verbal and written communications skills. (Required proficiency)
• Excellent interpersonal skills. (Required proficiency)
• Strong critical thinking / problem-solving skills. (Required proficiency)
• Strong analytical skills. (Required proficiency)
• Ability to maintain confidentiality and professionalism. (Required proficiency)
• Ability to work independently with minimal supervision. (Required proficiency)
• Ability to gather, analyze and make recommendations/decisions based on data. (Required proficiency)
• Ability to convey complex or technical information in an easy-to-understand manner. (Required proficiency)

Licenses and Certifications

• Certified Coding Specialist (CCS) - American Health Information Management Association - upon hire - Required or
• Certified Professional Coder (CPC) - American Academy of Professional Coders - upon hire - Required or
• Certified Coding Specialist-Physician-Based (CCS-P) - American Health Information Management Association - upon hire - Required
• Registered Health Information Administrator (RHIA) - Registered Health Information Administrator - American Health Information Management Association - upon hire - Preferred
• Registered Health Information Technician (RHIT) - Registered Health Information Administrator - American Health Information Management Association - upon hire - Preferred

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 receive an annual influenza vaccine. Learn more.

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SALARY RANGE:

Salary ranges are shown for full-time jobs. If you're working part-time, your pay will be adjusted accordingly.

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At CHOP, we are committed to fair and transparent pay practices. Factors such as skills and experience could result in an offer above the salary range noted in this job posting. Click here for more information regarding CHOP's Compensation and Benefits.