Review and check certain inpatient records to make sure the coding is correct and follows rules for ICD-10 codes. This includes checking the DRG groups, Present on Admission indicators, Severity of Illness, Risk of Mortality, Hospital-Acquired Conditions, and Patient Safety Indicators according to guidelines set by the Centers for Medicare & Medicaid Services and the American Hospital Association. Provide ongoing feedback and training to the staff in the Coding unit.
Responsibilities*
- Excellent customer service when working with Coding/CDI staff, clinicians, and other Michigan Medicine employees.
- Strong knowledge of ICD-10 coding and understand the Official Coding Guidelines well.
- Ability to review clinical documents to decide what information is needed for accurate DRG, POA, SOI, and ROM scores.
- Communicate effectively with the Coding/CDI team to ensure good outcomes.
- Write appropriate questions to the clinical care team following AHIMA Query Policy.
- Skilled in writing appeal letters to third-party payers to support DRG denials.
- Attention to detail to perform tasks with accuracy.
- Able to work independently, be self-motivated, and adapt to changes in healthcare.
- Excellent verbal and written communication skills, with strong analytical thinking and problem-solving abilities.
- Strong organizational skills and the ability to manage multiple tasks in a fast-paced environment.
- Proficiency in using computers, including database and spreadsheet analysis, presentation software, word processing, and internet searches.
- Able to navigate the Electronic Health Record (EHR) to find and review necessary documents accurately.
- Experience using Michigan Medicine information systems/applications is preferred.
Duties & Responsibilities:
- Review a selection of Coding work to ensure accuracy and identify missed query opportunities.
- Give regular feedback to Coding staff to help them improve the accuracy of their work, reflecting the complexity of patient care and hospital reimbursements.
- Continuously check the quality of clinical documentation to find incomplete or inconsistent records and create training programs as needed.
- Develop and coordinate training programs on coding compliance, including proper documentation, accurate coding, trends found in chart reviews, audit findings, and regular coding updates.
- Identify and address missed query opportunities for Coding/CDI staff.
- Train new Coding staff on proper coding procedures.
- Review and provide documentation to support appeals for DRG denials from third-party payers to prevent financial loss.
- Implement corrective action plans and educational programs to prevent future denials and rejections, including writing letters to the AHA and CMS for coding advice and recommendations.
- Suggest changes to ICD-10 codes by writing recommendations to the AHA.
- Conduct chart reviews and respond to coding requests from UMHS staff.
- Review updates in Coding Clinics and the Federal Register and share these updates with the team.
- Troubleshoot and resolve MiChart billing issues related to inpatient coding.
- Check clinical documentation for signs, symptoms, lab results, diagnostic info, and treatment plans to create appropriate queries for clinicians.
- Use 3M 360 Code Audit and Prebill tools during audits to ensure accurate data reporting.
- Support changes in documentation processes, like improving EHR data capture or redesigning templates.
- Identify documentation trends to be shared with clinical services and physician advisors for clinician education.
- Prepare specific documentation examples and PowerPoint presentations for clinical teams and departments.
- Stay updated with the processes, tools, and applications needed for job functions.
- Participate in the Michigan Quality System/Continuous Quality Improvement initiatives and apply Lean Thinking concepts to daily tasks.
- Show initiative by continuously learning new information and skills.
- Attend and participate in department activities, including staff meetings and training sessions.
- Perform other tasks as assigned to help keep the department running smoothly.
Required Qualifications*
- Registered Health Information Technologist or Administrator (RHIT/RHIA) or CCS with Associate’s degree required.
- Minimum of three years of experience with ICD-10 inpatient coding required.
- Prior experience coding in an academic medical center.
- Extensive knowledge of ICD-10-CM and PCS coding guidelines, DRG process, POA, SOI, and ROM scoring, writing third-party appeal letters as well as compliance requirements.
- Broad knowledge of federal, state, and payer-specific regulations and policies about documentation, coding, and billing.
Modes of Work
Mobile/Remote - the work requirements allow for the majority or all the work to be completed offsite. On occasion, the employee may be required and must be available to work onsite if necessitated by unit leadership or their designee and/or the job requirements.
Application Deadline
Job openings are posted for a minimum of seven calendar days. The review and selection process may begin as early as the eighth day after posting. This opening may be removed from posting boards and filled anytime after the minimum posting period has ended.
U-M EEO/AA Statement
The University of Michigan is an equal opportunity/affirmative action employer.
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