Job Title:Quality Coding and Documentation Educator II
Location: PA Homeworker / Northeastern Region (Luzerne and Lackawanna Counties)
Department:Geisinger at Home – Quality, Coding and Documentation
Work Schedule: Full Time
Working with minimal supervision, the CPSL Coder II, provides training and process improvement efforts across the clinical practices for the development of consistent and comprehensive clinical practices supported by the Geisinger Health Plan. With thorough working knowledge of clinical practice management and thorough data analysis, identifies process improvement opportunities associated with the management of risk adjustment initiatives. Investigates current processes, assessing efficiency and accuracy and provides solutions for problems, process improvement, development of training programs, and documentation strategies that support ICD-10 complex terminology for clinical practice operations and management. Serves as a liaison between Clinical Operations and the Risk and Revenue Management team, and facilitates communication between various constituents in order toassist in capturing chronic disease burden of the clinical enterprise patient population.
As a group, this position will be responsible to code all services provided at CPSL sites to ensure accurate reimbursement, code all risk-adjustment eligible lines of business (Commercial Exchange/AON Exchange, Medicare, Medicaid, CHIP) to ensure accurate reimbursement and contribute to the overall fiscal health of the organization.
COMPETENCIES AND SKILLS:
Demonstrates competency in the use of computer applications, IDX, software related Medicare edits, and all coding and abstracting software/hardware currently in use by Hospital and Professional Coding Operations.
Demonstrates updated skills required for the ICD-10-CM and ICD-10-PCS coding system
Demonstrates advanced skills in extracting and analyzing clinical documentation.
Demonstrates superior knowledge of anatomy and physiology along with disease pathophysiology.
Demonstrates knowledge in the encoder software and the EMR (EPIC) and uses these tools along with their knowledge in the anatomy and physiology of the human body and disease processes in order to understand the etiology, pathology, symptoms, signs, diagnostic studies, treatment modalities, and prognosis of diseases and chronic conditions to be coded.
Thorough understanding and application of new and expanded coding guidelines for both ICD-10-CM and ICD-10-PCS.
Demonstrates accurate understanding of procedural codes in the complex ICD-10-PCS code set.
Demonstrates excellent interpersonal skills to develop relationships necessary to influence physician documentation process.
Demonstrates analytic skills necessary to clinically assess medical records.
Demonstrates excellent prioritization and organizational skills.
Demonstrates proven analytical ability.
Demonstrates ability to work with minimal supervision at a high level of accuracy and productivity.
Demonstrates ability to communicate both verbally and in writing in a highly professional manner.
Demonstrates ability to be punctual and maintain an excellent attendance record.
Demonstrates ability to be articulate, mature, and highly organized.
Demonstrates ability have close attention to detail viewing a computer monitor, reading reports in electronic format, and reading physician handwriting.
Demonstrates ability to meet deadlines and function under pressure.
Demonstrates strict confidentiality of financial and medical records.
Ability to maintain a minimum 95% accuracy rate in professional coding while maintaining or exceeding established productivity benchmarks.
3. Minimum (3) years’ experience in either hospital or professional coding in any setting or (3) years’ as a Coder I with successful completion of our proficiency assessment with an accuracy rate of 95%
In lieu of the above, will consider:
1. RN, LPN with minimum two (2) years’ experience in either hospital or professional coding required.
2. RHIT or RHIA eligible (Hospital certification), with a minimum two (2) years’ experience in either hospital or professional coding required.
3. BS in a Health Care related field with a minimum two (2) years’ experience in either hospital or professional coding setting required.
Must be able to demonstrate progress toward a core competency analysis prior to final hiring process.
Intermediate knowledge of ICD-10-CM, ICD-10-PCS and CPT-4 coding principles, medical terminology, anatomy and physiology, disease processes, and Coding Clinic guidelines required (these will be tested prior to hiring and at least quarterly).
Knowledge of CMS, Medicaid and third party payer coding, billing and compliance regulations preferred.
Prior experience with and/or use of an encoder preferred.
If a suitably experienced candidate cannot be found, applicants who meet the basic qualifications but possess fewer years of experience will be considered for hire at a lower level.Salary would commensurate with experience.
WORKING CONDITIONS/PHYSICAL DEMANDS:
Work is typically performed in an office environment.
Travel may be necessary.
The specific statements shown in each section of this description are not intended to be all-inclusive. They represent typical elements considered necessary to successfully perform the job.
OUR PURPOSE & VALUES: Everything we do is about caring for our patients, our members, our students, our Geisinger family and our communities. KINDNESS: We strive to treat everyone as we would hope to be treated ourselves. EXCELLENCE: We treasure colleagues who humbly strive for excellence. LEARNING: We share our knowledge with the best and brightest to better prepare the caregivers for tomorrow. INNOVATION: We constantly seek new and better ways to care for our patients, our members, our community, and the nation.
GEISINGER HEALTH PLAN (GHP) is the health insurance component of Geisinger and serves over 460,000 members in Pennsylvania and West Virginia. Begun in 1985, GHP provides high quality, affordable health-care benefits for businesses of all sizes, individuals and families, and Medicare beneficiaries.
About Geisinger: Geisinger is a physician-led health system comprised of approximately 30,000 employees, including nearly 1,600 employed physicians, 13 hospital campuses, two research centers, and a 583,000-member health plan Geisinger is nationally recognized for innovative practices and quality care. Geisinger serves more than 3 million people in central, south-central and northeast Pennsylvania and also in southern New Jersey with the addition of National Malcolm Baldridge Award recipient AtlantiCare, A member of Geisinger. In 2017, the Geisinger Commonwealth School of Medicine became the newest member of the Geisinger Family.
We offer healthcare benefits for full time and part time positions from day one, including vision, dental and domestic partners.* Perhaps just as important, from senior management on down, we encourage an atmosphere of collaboration, cooperation and collegiality. For more information, visit www.geisinger.org, or connect with us on Facebook, Instagram, LinkedIn and Twitter.
** Does not qualify for J-1 waiver.We are an Affirmative Action, Equal Opportunity Employer Women and Minorities are Encouraged to Apply.All qualified applicants will receive consideration for employment and will not be discriminated against on the basis of disability or their protected veteran status.
*Domestic partner benefits not applicable at Geisinger Holy Spirit.
At Geisinger, our innovative ideas are inspired by the communities we serve – like our Fresh Food
Farmacy, a program that delivers life-saving healthy alternatives to patients with diabetes. With additional tools like our MyCode Community Health Initiative, one of the first health system genome sequencing
programs, and our new asthma app suite that we developed in partnership with AstraZeneca, it’s no wonder we’re ranked one of the Top 5 Most Innovative Healthcare Systems by Becker's Hospital Review. We continually work towards continuous improvement in a culture where everyone has a voice and firmly believe that better begins with all of us.
Founded more than 100 years ago, Geisinger serves more than three million residents throughout central, south-central and northeastern Pennsylvania and southern New Jersey. Our physician-led system is comprised of 30,000 employees, including 1,600 employed physicians, and consists of 13 hospital campuses, the Geisinger Health Plan, Geisinger Commonwealth School of Medicine and two research centers.
What you do at Geisinger shapes the future of health and improves lives – for our patients, communities, and you.