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UPMC complies with all governmental requirements related to local, state, and federal COVID-19 vaccination for employment. The Jan. 13 Supreme Court of the United States decision that the Centers for Medicare & Medicaid Services federal COVID-19 vaccine mandate will move forward requires UPMC to ensure employees either get vaccinated or receive a requested medical or religious exemption.

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Proof of vaccination is not required upon hire; however, employees will be responsible for ensuring post-hire compliance by getting vaccinated or requesting a medical or religious exemption.

For more information about UPMC’s response to COVID-19, please visit UPMC.com/coronavirus.

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   Current UPMC employees must apply in HR Direct

Mgr, Coding Auditor - Educator

  • Job ID: 314025259
  • Status: Full-Time
  • Regular/Temporary: Regular
  • Hours:
  • Shift: Day Job
  • Facility: UPMC Pinnacle Hospitals
  • Department: Health Infor-Coding-HBG
  • Location: 111 South Front Street, Harrisburg PA 17105
  • Union Position: No
  • Salary Range: $37.44 to $56.16 / hour

Description

Purpose:
The Manager of Coding Audit/Education is responsible for post discharge data quality validation/concurrent and pre-bill audits of inpatient and outpatient cases. Validates the documentation that supports the final MS-DRG assignment and is in compliance with the official coding guidelines as supported by clinical documentation in health record. Identifies potential documentation improvement opportunities and MS-DRG opportunities, researches appropriate guidelines to support recommended changes and communicates the changes to coding in a timely manner. Provides documentation education and expert Coding/CDI advice to the Coding and CDI staff. Develops educational programs which provides Coding/CDI education, in conjunction with the Coding and CDI Managers for the new Coding/CDI employees and ongoing education for all Coding/CDI staff. This individual communicates with leadership, compliance department members, providers (physicians and extenders.) Health Information coding and CDI staff regarding coding audit issues, current coding regulations and concerns.

Responsibilities:

  • Consistently demonstrates appropriate and professional communication behavior toward care providers, patients and co-workers. Cooperates with Management and peers to promote an environment of teamwork and collaboration. Promotes Mission, Vision, Values and a professional manner at all times.
  • Maintains an open dialogue, promotes collaboration and good working relationship with all members of the Health Information department, provider and all hospital staff. Performs other department duties as assigned.
  • Serves as a resource for department manager, staff, physicians and administration to obtain information or clarification on accurate and ethical coding and documentation standards, guidelines and regulatory requirements.
  • Proactive thinking and recommends action for improving coding compliance.
  • Participates as a member of the Compliance Advisory Council and any other Committees as appropriate.
  • Professional Development: Stays current with licensure requirements as well as AHA Official Coding and Reporting Guidelines, CMS and other agency directives for Clinical Documentation Improvement programs. Attends any educational events related to documentation and coding guidelines. Stay current with Coding Clinic and provides Coding Clinic, CMS, OIG, RAC/QIO regulations and reimbursement guidelines and advice as they apply to MS-DRG assignment.
  • Education: Communicates effectively the audit findings (to include opportunities) with Coding/CDI teams, maintaining positive relationships to effectively address and resolve issues. Serves as a resource for department manager, staff, physicians and administration to obtain information or clarification on accurate and ethical coding and documentation standards, guidelines and regulatory requirements
  • Data Quality: Reviews medical record documentation for quality, to include Severity of Illness and Risk of Mortality cases. Demonstrates ability to achieve accuracy and consistency in the selection of principal and secondary diagnosis (including MCC & CC) and procedures. Uses industry standard reports (PEPPER and Crimson) as a tool/guide for identifying assessment opportunities.
  • Analyzes data, identifies trends/conclusions (e.g., coding practices, case-mix changes, etc.), and proposes strategies for resolution and education opportunities. Provides education support on documentation, coding, and billing. Prepares and presents educational programs related to coding
  • Reviews claim denials and rejections pertaining to coding and medical necessity issues and implements corrective action
  • Validation: Coding/CDI chart review, validation, and auditing. Reviews the medical records to validate complete and accurate documentation, which supports the code and MS-DRG assignments, identifies any potential diagnoses and procedures that may have been missed, communicates opportunity to appropriate staff and validates concurrent and/or retrospective queries for compliance. Follows industry coding and documentation guidelines (e.g., Official ICD coding guidelines, Coding Clinic advice, coding policies and procedures, and AHIMA/ACDIS Query guidelines) to maintain system-wide coding consistency and to remain in compliance with governmental and other regulatory guidelines.
  • Educator: Develops comprehensive Coding/CDI orientation plan for all new Coding/CDI staff in conjunction with Coding/CDI managers. Conducts ongoing staff education and develops the education program materials, including online materials, handouts, PowerPoint presentations, etc.

A highlight of this position is the hybrid work schedule available once training is completed! 

 

Qualifications

Associate or Bachelor degree in Health Information Management.RHIA, RHIT or CCS credentials required.RN with CCS, preferred. Must have one of the following; or have within one year of employment:CDI Credential CCDSCDI Credential CDIP Extensive knowledge of ICD-10 and CPT-4. Minimum of 3-5 years of coding or review experience.3-5 years of management, and/or teaching/training experience.Minimum of 3-5 years of hospital coding, including knowledge of CAC coding/grouper.Knowledge of federal, state and payer-specific regulations and policies pertaining to documentation, coding and billing.Knowledge of Medicare and all payer reimbursement methodologies.Familiar with audit management techniques.Must be self-motivated and have the ability to work within the established policies, procedures and practices prescribed by PinnacleHealth System and the Director, Health Information Management.Must work with deadlines and related time pressure.Knowledge of statistics, data collection, analysis and data presentation. Proficient with Microsoft software (Word, Excel and PowerPoint).Excellent interpersonal communication and problem solving skills.Excellent written and oral communication skills.Preferred Knowledge, Skills and Abilities:Minimum of 3 years Clinical Documentation Improvement experience.

Licensure, Certifications, and Clearances:
Clearances must be dated within 90 days
 

  • Act 33 with renewal
  • Act 34 with renewal
  • Act 73 FBI Clearance with renewal

  • UPMC is an Equal Opportunity Employer/Disability/Veteran

COVID-19 Vaccination Information

Individuals hired into this role must comply with UPMC’s COVID vaccination requirements upon beginning employment with UPMC. Refer to the COVID-19 Vaccination Information section at the top of this page to learn more.

Total Rewards

More than just competitive pay and benefits, UPMC’s Total Rewards package cares for you in all areas of life — because we believe that you’re at your best when receiving the support you need: professional, personal, financial, and more.

Our Values

At UPMC, we’re driven by shared values that guide our work and keep us accountable to one another. Our Values of Quality & Safety, Dignity & Respect, Caring & Listening, Responsibility & Integrity, Excellence & Innovation play a vital role in creating a cohesive, positive experience for our employees, patients, health plan members, and community. Ready to join us? Apply today.

   Current UPMC employees must apply in HR Direct