JOB SUMMARY: Provides leadership in sharing current and relevant coding subject matter expertise with staff. Performs audits of inpatient and/or outpatient coding. Understands and applies quality standards to all aspects of the documentation integrity program. Identifies areas for strategic audits, coding education and improvement. Supports denials management process and other initiatives.
Reviews documentation to ensure assigned codes are supported. Recognizes documentation clarification opportunities and works with team to secure additional documentation.
Assigns codes that most appropriately reflect documentation of the patient stay, severity of illness, risk of mortality, and resources utilized during the patient encounter.
Writes explanations to support or rebut coding recommendations and appeals for denied or downcoded encounters.
Participates in accurate data collection, analysis, evaluation, problem solving and recommendations of process improvements.
Performs pre and post-bill reviews, qualitative review and prospective third party payor reviews based on identified issues. Performs prebill reviews and education for new coders.
Performs data analysis of the audit program ,findings, and other source data, to identify trends and patterns. Creates detailed reports based on audit findings and facilitates change processes.
The responsibilities listed are a general overview of the position and additional duties may be assigned.
MEDICAL CODING (EXPERT):- The transformation of healthcare diagnosis, procedures, medical services, and equipment into universal medical alphanumeric codes.
MEDICAL TERMINOLOGY & DOCUMENTATION (EXPERT):- The ability to comprehend medical terminology and documentation in an office, or surgical setting.
CRITICAL THINKING (ADVANCED):- The objective analysis and evaluation of an issue in order to form a judgment.
COMPLIANCE (ADVANCED):- Understanding the rules, regulations, sanctions and other statutory requirements, guidelines and instructions relating to governing bodies and organizations, both internally and externally.
WRITTEN COMMUNICATION (ADVANCED):- Demonstrates the ability to write clear, detailed, and comprehensive status reports, memos and documentation. Demonstrates an understanding of effective composition, such as having first line in a paragraph state the subject.
VERBAL COMMUNICATION (ADVANCED):- Ability to enunciate clearly, using appropriate voice control and body language. Effectively transmits technical and business ideas and information to others. Listens carefully to ascertain points being made before trying to be understood.
PEER LEADERSHIP (INTERMEDIATE):- The ability to show leadership and influence people of equal rank in an effort to accomplish team goals.
Organizational Impact: Delivers projects/assignments that have a direct impact on goals/objectives of the unit/department that the job is in.
Problem Solving/ Complexity of work: Conducts extensive analysis of situations or data to resolve numerous, complex issues; may involve the input/work of others.
Breadth of Knowledge: Has in-depth level of knowledge within a professional area and working knowledge of other areas.
Team Interaction: May lead mid-sized projects; coaches and guides team members.
SUPPORTING COLLEAGUES (P4):
- Develops Self and Others: Invests time, energy and enthusiasm in developing self/others to help improve performance and gain knowledge in new areas.
- Builds and Maintains Relationships: Maintains regular contact with key colleagues and stakeholders using formal and informal opportunities to expand and strengthen relationships.
- Communicates Effectively: Recognizes group interactions and modifies one's own communication style to suit different situations and audiences.
DELIVERING EXCELLENT SERVICES (P4):
- Serves Others with Compassion: Seeks to understand current and future needs of relevant stakeholders and customizes services to better address them.
- Solves Complex Problems: Approaches problems from different angles; Identifies new possibilities to interpret opportunities and develop concrete solutions.
- Offers Meaningful Advice and Support: Provides ongoing support and coaching in a constructive manner to increase employees' effectiveness.
ENSURING HIGH QUALITY (P4):
- Performs Excellent Work: Engages regularly in formal and informal dialogue about quality; directly addresses quality issues promptly.
- Ensures Continuous Improvement: Applies various learning experiences by looking beyond symptoms to uncover underlying causes of problems and identifies ways to resolve them.
- Fulfills Safety and Regulatory Requirements: Understands all aspects of providing a safe environment and performs routine safety checks to prevent safety hazards from occurring.
MANAGING RESOURCES EFFECTIVELY (P4):
- Demonstrates Accountability: Demonstrates a sense of ownership, focusing on and driving critical issues to closure.
- Stewards Organizational Resources: Applies understanding of the departmental work to effectively manage resources for a department/area.
- Makes Data Driven Decisions: Demonstrates strong understanding of the information or data to identify and elevate opportunities.
FOSTERING INNOVATION (P4):
- Generates New Ideas: Proactively identifies new ideas/opportunities from multiple sources or methods to improve processes beyond conventional approaches.
- Applies Technology: Demonstrates an enthusiasm for learning new technologies, tools, and procedures to address short-term challenges.
- Adapts to Change: Views difficult situations and/or problems as opportunities for improvement; actively embraces change instead of emphasizing negative elements.
Vanderbilt University Medical Center is home to Vanderbilt University Hospital, The Monroe Carell Jr. Children’s Hospital at Vanderbilt, the Vanderbilt Psychiatric Hospital and the Vanderbilt Stallworth Rehabilitation Hospital. These hospitals experienced more than 61,000 inpatient admissions during fiscal year 2015. Vanderbilt’s adult and pediatric clinics treated nearly 2 million patients during this same period. Vanderbilt University Hospital and the Monroe Carell Jr. Children’s Hospital at Vanderbilt are recognized again this year by U.S. News & World Report’s Best Hospitals as among the nation’s best with 18 nationally ranked specialties. Vanderbilt University Medical Center is world renowned because of the innovation, work ethic and collegiality of its employees. From our health care advances to our compassionate care, Vanderbilt owes its accomplishments and reputation to staff and faculty who bring skill and drive and innovation to the medical center day after day. World-leading academic departments and comprehensive centers of excellence pursue scientific discoveries and transformational educational and clinical advances across the entire spectrum of health and disease.As t...he largest employer in middle Tennessee, we welcome those who are interested in ongoing development in a caring, culturally sensitive and professional atmosphere. Most of us spend so much of our lives at work, we want to be part of maintaining a workplace in which people support one another and encourage reaching for excellence. Many high-achieving employees stay at Vanderbilt because of the professional growth they experience and because of their appreciation of Vanderbilt’s benefits, public events and discussions, athletic opportunities, beautiful setting and, above all, sense of community and purpose.Vanderbilt and its employees share a set of mutual expectations that have been created with productivity, legality, fairness and safety always in mind. We believe that our investment in training and compensating employees multiplies in value when we enable individuals to deliver their best performance for the benefit of us all.