About NYC Health + Hospitals NYC Health + Hospitals is the largest public health care system in the United States. We provide essential outpatient, inpatient and home-based services to more than one million New Yorkers every year across the city’s five boroughs. Our large health system consists of ambulatory centers, acute care centers, post-acute care/long-term care, rehabilitation programs, Home Care, and Correctional Health Services.
Our diverse workforce is uniquely focused on empowering New Yorkers. At NYC Health + Hospitals, our mission is to deliver high quality care health services, without exception. Every employee takes a person-centered approach that exemplifies the ICARE values (Integrity, Compassion, Accountability, Respect, and Excellence) through empathic communication and partnerships between all persons.
Work Shifts 9:00 A. M – 5:00 P. M Duties & Responsibilities Purpose of Position: Under direction, provides centralized oversight of medical records and coding staff specializing in health information and clinical documentation management to ensure the maximum clinical documentation quality and coding.
Analyzes and reviews provider documentation, claims and clinical data to ensure accuracy of all reported International Classification of Diseases (ICD) diagnoses and procedure codes to the highest-level descriptor to support the patient’s acute/chronic conditions and treatment plans as well as reflect the appropriate severity of illness/risk of mortality of NYC Health + Hospitals’ patient population. Performs quality reviews of health information documentation, contributes to the proper reporting of code assignment in order to facilitate consistent and efficient claims processing, data collection and quality metrics.
Ensures patient centered quality of care; providing optimal utilization of resources, service delivery, and adheres to all relevant regulatory policies, procedures, and meet standards of care for better outcomes and improved patient experience.
and
Performs pre-visit/retrospective current and/or longitudinal reviews for completeness. In addition, substantiate all ICD Procedural Coding System (PCS) diagnostic and therapeutic procedures or the AMA Current Procedural Terminology (CPT) Codes are reported affecting utilization and statistics. Captures and assesses physician documentation and queries for compliance in accordance with established guidelines, conventions and industry standards and meet the criteria for the ICD diagnoses codes used for Risk Adjustment Factors (RAF) scores to identify areas for educational opportunity for clinical and non-clinical staff, which will impact patient care and supportive services.
Generates physician queries based on documentation and clinical indicators for suspected conditions that impact quality and/or reporting, so the physician may consider a definitive diagnoses and/or document clarification of specificity as requested into the health record. Provides feedback to facility staff on missed opportunities for documentation improvement. Ensures adherence to established policy and procedures.
Engages in the evaluation of administrative systems employed in maintenance and utilization of health information records. Performs data quality assurance reviews for system functions and usage. Analyzes usage reports to identify trends in documentation inconsistencies, inadequacies and other issues to determine root cause, including but not limited to focused reviews i.e.
Patient Safety Indicators (PSI) and Hospital Acquired Conditions (HAC) and identify process improvement opportunities in collaboration with the Quality professionals. Performs post-billing quality reviews and analysis of coding edits to identify resolution, automation, education or re-training to facilitate the processing of clean claims for billing. Participates in the denial review process to establish evidence of clinical or documentation to support the current billing which may include writing an appeal letter with said evidence to retain proper reimbursement.
Ensures all denials are responded to in a timely manner for tracking and provides feedback to appropriate staff, as needed. Assists in the development, implementation and management of performance standards and strategic planning through preparation and/or presentation of financial statistics for Enterprise-level reporting for physician advisors, clinical leadership and key stake holders. Responsible for maintaining knowledge of regulations and updates in the reporting of ICD codes, disease pathophysiology and documentation requirements.
Provides updates to staff, as necessary. Participates in the development and/or facilitating of training programs that provide systemwide education on documentation requirements in various healthcare settings, reimbursement and regulatory changes. Participates in facility new associate orientation, instructs and mentors appropriate staff, as needed.
Acts as a subject matter expert resource and liaison with internal and external professional groups. Acts as a departmental representative on various committees or work groups. Assists in interdisciplinary efforts to review existing documentation and coding policies and procedures and makes necessary recommendations for improvement.
May participate in performance measures and research activities. Performs related duties, as assigned.
1. Three (3) years of clinical experience as a Registered Professional Nurse (RN) and an additional two (2) years of Clinical Documentation experience; and valid certification from a nationally accredited organization in Coding or Clinical Documentation; or 2. One (1) year of clinical experience as a Nurse Practitioner (NP) or Physician Assistant (PA) and an additional two (2) years of Clinical Documentation experience; and valid certification from a nationally accredited organization in Coding or Clinical Documentation; or 3.
Medical School Graduate; and two (2) years of medical record review, utilization review or case management experience; and valid certification from a nationally accredited organization in Coding or Clinical Documentation; or 4. Valid Registered Health Information Administrator (RHIA) credential from the American Health Information Management Association (AHIMA) or a Registered Health Information Technician (RHIT) credential from AHIMA; and three (3) years of satisfactory experience in Diagnosis-Related Group (DRG) validation and coding; or 5.
High school diploma or its educational equivalent; and valid coding certificate from a nationally accredited association (i.e., Certified Coding Specialist (CCS) from AHIMA or Certified Professional Coder (CPC)); and six (6) years of satisfactory experience in coding, abstracting medical records and DRG validation in a healthcare environment. Department Preferences In-depth understanding of MS-DRG methodology and Medicare inpatient prospective payment system (IPPS) Expert knowledge of ICD-10-CM/PCS coding guidelines and Official Coding Guideline Strong knowledge of clinical validation principles, including severity of illness (SOI) and risk of mortality (ROM) Familiarity with payer policies, medical necessity criteria, and denial trends impacting inpatient claims Knowledge of CDI workflows, physician query standards, and documentation best practices Understanding of quality indicators, including PSI, HAC, and mortality measures affected by coding and documentation Working knowledge of Electronic Health Record (EHR) systems, coding encoders, and auditing/validation tools Knowledge of compliance, audit, and regulatory requirements related to inpatient coding and reimbursement.
Must have at least 2 years’ experience as a DRG Validator with a minimum of 3 years’ experience coding in an acute care setting. Benefits NYC Health and Hospitals offers a competitive benefits package that includes: Comprehensive Health Benefits for employees hired to work 20+ hrs. per week Retirement Savings and Pension Plans Paid Holidays and Vacation in accordance with employees' Collectively bargained contracts Loan Forgiveness Programs for eligible employees College tuition discounts and professional development opportunities College Savings Program Union Benefits for eligible titles Multiple employee discounts programs Commuter Benefits Programs How To Apply If you wish to apply for this position, please apply online by clicking the "Apply for Job" button.