Job Description

Job Summary:

Primarily identify, collect, assess, monitor, and document diagnosis (ICD) coding information. The analyst will work closely with the departmental leadership auditors and management to impact the collection of additional diagnoses and HEDIS data through clinical documentation review. Participates in trend identification and analysis on an ongoing basis, regarding TSPMG practitioners, and additional clinical areas as requested, utilizing established documentation and coding criteria. These include but are not limited to; application of documentation standards; validation of health record completeness; process studies and verification; regulatory, accrediting audits, coding compliance and documentation analysis and validation; etc. Concurrent analysis of coding of (CMS) Medicare encounters provides coding assistance through interpretation of guidelines, training support, and query / communication to practitioners. Performs validations and prepares queries for practitioners on their medical service / clinical documentations and code assignments to ensure that KPSE (Georgia) receives appropriated reimbursement and conforms to applicable guidelines and regulations (Federal, State, and Internal). In addition, this position insures KP is meeting State and other regulatory requirements around lifelong monitoring of cancer patients. Responsible for all required daily activities associated with collecting, summarizing, abstracting detailed demographic and clinical oncology information from a variety of internal and external (paper and electronic) data sources in accordance with reporting requirements of the Georgia Tumor Registry and data standards for the American College of Surgeons Commission on Cancer on all reportable cases. Accurate and complete documentation are required for this compelled reporting. This position also supports accurate Medicare risk adjustment reporting and potentially healthcare exchanges. Maintains lifetime follow -up on each reportable case. Coordinates the maintenance of specialized databases to ensure the accuracy of all registry information. Ensures the timely preparation and submission of periodic and ad hoc reports required by regulatory agencies, physicians, researchers, and others. Partners with contracted and other healthcare providers / facilities that have been involved in patient treatment. Ensures state reporting requirements to fulfill the overarching compelled reporting governed by CDC. Ensures the highest quality standards and compliance with State requirements on behalf of the organization.

Essential Responsibilities:

• Data / documentation and coding validation and analysis. Authorized to modify assigned codes based on clinical documentation review and queries / issues requiring clarification by clinician.
• Assists in the design, modification, and implementation of approved best practices / recommendations of coding edit software. Participates with some supervision in test environments as UAT candidates (user acceptance testing). Document and present analysis to leadership on a project basis. Supports specialty-specific training to practitioners on documentation of services, appropriate coding of level of service, diagnosis and procedures code assignments through interpretation of appropriate coding guidelines. Supports training at the department, team, or individual level as needed.
• Maintains up-to-date knowledge regarding professional health information practices, as well as standards and regulatory requirements related to health information management and coding compliance (Federal, State, internal).
• Participate in task force groups as requested interacts with leadership, practitioners, and staff regarding health information and coding issues.
• Conducts regional and various departmental training sessions.
• Serves as a subject matter coding expert on Medicare Risk Adjustment and additional clinical specialty-based coding.
• Conducts an extensive analysis of patient records to evaluate documentation of applicable diagnoses related to Oncology and other secondary diagnoses.
• Obtains and promotes appropriate clinical documentation through extensive interaction and research with physicians, nursing staff, and other internal and external resources.
• Links ICD-0 and ICD coding guidelines and medical terminology to improve accuracy of patient severity of illness, risk of mortality and final code assignment.
• Reviews medical record to ensure American Joint Committee on Cancer (AJCC) Staging Manual, Surveillance, Epidemiology and End Results (SEER), and the Facility Oncology Registry Data Standards (FORDS) of the Commission on Cancer are followed.
• Maintains working relationships with physicians and other caregivers.
• Compiles data and analysis to determine areas of documentation and coding improvement opportunities, physician and staff training and to improve coding capture and accuracy.
• Acts as a liaison between coding operations, coding auditing, clinicians, and other partners to identify trends and develop remediation approach and execute actions as defined.
• Responsible for on-time, lifetime follow-up reporting for all required cases.
• Maintenance and fulfillment of all required CEs to maintain credentials through AHIMA required
• Other duties as assigned.

Basic Qualifications:
Experience

• Minimum seven (7) years of outpatient direct coding assignment and validation experience.
• Minimum three (3) years of experience in tumor registry.
• Minimum two (2) years of direct Cancer Registry.
• Minimum two (2) years of direct Risk Adjustment coding experience.

Education

• Associates degree or completion of two (2) years of college level courses in health information, business administration, information systems, health care delivery or two (2) years of experience in a directly related field. High School Diploma or General Education Development (GED) required.

License, Certification, Registration

• Tumor Registrar Certificate within 12 months of hire
  

Additional Requirements:

• Demonstrated partnership with State Reporting Agencies.
• Excellent interpersonal and communication skills (verbal and written).
• Strong time management and analytical skill

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