University Hospitals

• Collaborates and coordinates with all members of the health care team, patient and family (or significant others) to coordinate and ensure timely and efficient delivery of required workflow, services and tasks. • Perform timely and accurate denial communications and activity; clarify communications as needed, and collect additional information in preparation for Nurse review. • Support the denial/appeal management nurse in collaborating with physicians, UM Nurses, PAS, and other members of the Interdisciplinary team, Revenue Cycle and payers to collect and relay all pertinent information to support successful appeals. • Document appeal activity according to department standards to support accurate reporting. • Research and record appeals outcomes and produce reports related to denial and appeal outcomes.

• Develops and leads the project management, implementation, and facilitation of programs that support OD strategies and desired outcomes. • Designs curriculums, programs, workshops, and learning resources that are aligned with adult learning practices and research that reflects a diversity of learning styles. • Facilitates a variety of learning & development programs, presentations, trainings and onboarding activities. • Collects and assesses data regarding the effectiveness of learning & development initiatives. • Builds partnerships across the organization with to enhance learning and development programs, and ensure optimal outcomes for OD initiatives. • Effectively and consistently navigates ambiguous project environments; organizes work efforts and deliverables with a concern for order, quality, and accuracy. • Performs other duties as assigned.

• Leads needs assessment, software design, implementation and support. • Collaborates with reporting team to support operational partners need to gather requirements. • Independently facilitates design of workflows in conjunction with the appropriate subject matter experts; workflows will focus on designing improved efficiencies, solving complex workflow issues and incorporating quality initiatives. • Mentors other analysts with completing design workflows and analysis. • Leads functional and integrated testing of the software to ensure that the design objectives are met, including the development and validation of testing scripts. • Defines and develops user access security to protect the system while providing users with the access required. • Oversees, reviews, and moves build to production as required. • Comprehends with high degree of clinical or business departments’ processes and partners with them to develop supporting workflows. • Evaluates possible implementation of new technology, consistent with the goal of improving existing systems and technologies and in meeting the needs of the business. • Participates and contributes in operational meetings to provide Information Technology support and expertise. • Performs unit testing of all need build they are assigned and assists other application analyst as needed. • Leads functional and integrated testing of software to ensure that design objectives are met, including development and validation of testing scripts. • Develops, modifies and maintains integrated testing scripts owned by their areas. • Leads projects following the framework of the Enterprise Project Management Office on all phases of a project from scoping and design through implementation and transition to operations. • Collaborates across teams to develop change management strategy and plans for implementations. • Develops plans to address impacts from system changes when implementing new functionality. • Supports and troubleshoots interfaces for inbound/outbound transaction errors; helps monitor interface error queues. • Troubleshoots application issues, with/without vendor assistance to resolution. • Leads escalation of issues with appropriate internal resources, to resolution. • Independently leads application upgrade tasks and troubleshooting efforts and provides guidance to application analysts and leadership. • Maintains security for assigned applications. • Develops policies and procedures in collaboration with clinicians, other system analyst team members, and IT Epic team manager. • Creates and maintains system documentation; ensuring that documentation is updated accurately and timely. • Guides other team members in ensuring good documentation standards and coordinates efforts to maintain appropriate system documentation. • Provides input to components of development of end-user training materials and participates in training efforts.

Role Description Responsible for accurately and timely coding of outpatient and professional medical records following established coding, CMS regulations and hospital guidelines. - Reviews patient encounters and assigns diagnostic ICD-10-CM and/or procedural CPT codes according to established coding, CMS and hospital guidelines. - Responsible for accurately coding hospital ancillary, ED, same day surgery, observation and/or professional physician services encounters. - Maintains productivity and quality rate according to established standards. - Ensures optimal CPT /ASC/APC/APG assessment. - Understanding and ability to resolve coding specific edits such as CCI, LCD, NCD and MUE. - Works within UH billing time frames. - Maintains coding knowledge and skills via written coding resources, clinical information and educational webinars. - Maintains knowledge of guidelines and regulations affecting the UHHS Coding Department. - Maintains up to date credentials. - Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association (AHIMA). Qualifications - High School Equivalent / GED (Required) - Associate's Degree preferably in HIM (Preferred) - Bachelor's Degree (Preferred) - 1+ years of ICD-10-CM and/or CPT coding experience (Preferred) Requirements - Medical terminology, anatomy/physiology, pathophysiology and pharmacology knowledge (Required proficiency). - Detail-oriented and organized, with excellent time-management skills, and good analytical and problem-solving ability (Required proficiency). - Notable client service, communication, presentation and relationship building skills (Required proficiency). - Ability to function independently and as a team player in a fast-paced, demanding work environment (Required proficiency). - Strong written and verbal communication skills (Required proficiency). - Demonstrated ability to use PCs, Microsoft Office suite, and general office equipment (i.e. printers, copy machine, FAX machine, etc.) (Required proficiency). - Must be able to proficiently work within multiple systems (Required proficiency). Licenses and Certifications - Certified Professional Coder (CPC) CPC, CPC-A, CPC-H, or CPC-P (Required Upon Hire) - Certified Coding Specialist (CCS) CCS, CCS-P (Required Upon Hire) - Registered Health Information Technologist (RHIT) (Required Upon Hire) - Registered Health Information Administration (RHIA) (Required Upon Hire) - Certified Coding Associate (CCA) (Required Upon Hire) - Radiology Coding Certification (RCC) (Required Upon Hire) - Radiation Oncology Certified Coder (ROCC) (Required Upon Hire) - Certified Hematology and Oncology Coder (CHONC) (Required Upon Hire) Physical Demands - Standing: Occasionally - Walking: Occasionally - Sitting: Constantly - Lifting: Rarely up to 20 lbs - Carrying: Rarely up to 20 lbs - Pushing: Rarely up to 20 lbs - Pulling: Rarely up to 20 lbs - Climbing: Rarely up to 20 lbs - Balancing: Rarely - Stooping: Rarely - Kneeling: Rarely - Crouching: Rarely - Crawling: Rarely - Reaching: Rarely - Handling: Occasionally - Grasping: Occasionally - Feeling: Rarely - Talking: Constantly - Hearing: Constantly - Repetitive Motions: Frequently - Eye/Hand/Foot Coordination: Frequently Travel Requirements - 10%25

• Position responsible for submitting and resolving medical claims moderate to high complexity. • Must remain current with governmental and third party billing, follow-up and appeal requirements for compliant billing and follow-up of both inpatient and outpatient claims for all wholly owned facilities and physician entities including internal and external policy requirements. • Responds to requests from management, staff, or physicians in a timely and appropriate manner. • Maintains patient and physician confidentiality and professionalism at all times. • Follow department policies and procedures to ensure accurate and timely claim resolution. • Effectively communicates utilizing telephone, form letters, e-mail, or internal correspondence to resolve patient inquiries and insurance issues. • Attends and participates in team meetings. • Utilizes worklists to review and analyze account balances in order to collect payment for medical services rendered. • Utilizes multiple system applications to review, update patient information as well as research and resolve outstanding AR balance. • Assists in the analysis of claims resolution and provides feedback to management for solutions and process improvements. • Performs follow up with insurance companies to ensure appropriate payment on claims, resolve denials, correct claims, and appeal claims. • Acts as a liaison with internal and external customers providing assistance in claims and receivables resolution in a high volume environment. • Documents accounts with clear and concise verbiage in accordance with departmental procedures. • Reviews and responds to correspondence and inquiries received. • Meets and exceeds team productivity and quality standards. • Takes the lead on special projects. • Participates in staff training. • Reviews complex claims issues for resolution and recommends process improvements. • Performs other related duties as assigned.

• Ensures documentation is accurate and complete by performing timely medical record review and determination of code assignment by applying clinical and/or coding expertise to identify opportunities for improved or clarified documentation that accurately reflects the patient complexity and resource utilization. • Direct and timely follow-up with clinical providers to ensure requested clarification is provided. • Responsible and accountable for expanding CDI and coding knowledge (keeping up to date on latest research, technology, treatment modalities, etc.) • Utilizes critical thinking/problem solving processes • Appropriately utilizes and interprets professional association resource materials and regulatory agencies guidelines to enhance own skill sets: Coding Clinics, AHIMA, CMS guidelines • Identifies query opportunities for record integrity • Is proficient in query writing so that the question is easily understood by the physician • Query writing is AHIMA compliant per practice briefs • Escalates non-response to query by physicians immediately according to query escalation policy • Collaborates with the coding team • Demonstrates proficiency in reviewing increasingly complex cases. • Actively engages in educating physicians and other clinical care providers regarding clinical documentation in a variety of formats including participation in clinical rounding, service line focused education sessions and one to one case specific feedback. • Applies knowledge of health care workflows in order to work collaboratively with medical staff and other health care team members to improve the overall accuracy and comprehensiveness of medical record documentation, with focus on ensuring accurate reporting of quality outcomes.

• Responsible for accurately and timely coding of outpatient and professional medical records following established coding, CMS regulations and hospital guidelines. • Reviews all types of encounters and accurately codes diagnostic and procedural information following coding guidelines and regulations information including, facility specific guidelines and federal regulations. • Responsible for accurately coding hospital ancillary, ED, same day surgery, observation and/or professional physician services encounters. • Maintains productivity and quality rate according to established standards. • Ensures optimal CPT /ASC/APC/APG assessment. • Understanding and ability to resolve coding specific edits such as CCI, LCD, NCD and MUE. • Works within UH billing time frames. • Maintains coding knowledge and skills via written coding resources, clinical information and educational webinars. • Maintains knowledge of guidelines and regulations affecting the UHHS Coding Department. • Maintains up to date credentials. • Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association (AHIMA). • Participates in educational and informational activities. • Performs other duties as assigned. • Complies with all policies and standards.

• Applies clinical expertise and knowledge of health care workflows in order to educate and train CDI Specialists in the essential duties of their role to improve the overall accuracy and comprehensiveness of medical record documentation, with focus on ensuring accurate reporting of quality outcomes • Educates CDI Specialists on the rules/regulations associated with coding and clinical documentation integrity. • Trains newly hired CDI Specialists and provides ongoing coaching and education specific to daily CDI Specialist job functions. • Ensures the work output of the Clinical Documentation Integrity staff is accurate and compliant. • Collaborates with CDI leadership and Coding team to identify training opportunities and assist with education of CDI and Coding staff with regard to clinical documentation integrity and/or clinical and coding scenarios as needed. • Performs post-discharge, final coded, pre-bill reviews of targeted records identified for second-level review for opportunity to accurately capture patient acuity, severity of illness, risk of mortality, and DRG assignment in compliance with industry rules and regulations. • Documents SLR findings within CDI application. • If a documentation opportunity is identified, place physician query and follow up for response to ensure completeness and accuracy of the medical record. • If coding opportunity is identified, coordinate with coder and/or Coding Leadership to review and address opportunity as applicable. • Serves as a role model and resource for CDI team members. • Subject matter expert that exhibits excellent skills in essential components of the CDI Specialist role. • Responds to CDS requests for concurrent chart reviews on challenging cases with recommendations and supporting rationale. • Performs concurrent second level reviews based on defined criteria and shares feedback with CDI Specialist assigned to the encounter for action on opportunities identified. • Maintains a summary of opportunities identified through second level review for feedback and education with the CDI team. • Coordinates with other Second Level Reviewers, CDI Leads, and CDI Educator to compile trends and areas of opportunity and conduct education both 1:1 and group education with the CDI team based on the findings. • Periodically review the criteria established for cases triggering a second level review and recommend updates or modifications to the criteria to assist in identifying areas of opportunity. • Is actively engaged in quality and process improvement efforts. • Performs targeted audits as assigned in support of department initiatives. • Participates in quality initiatives such as HAC/PSI and US News/Mortality. • Collaborates with CDI Leadership, Leads and Educators to optimize query templates. • Identifies and shares feedback regarding workflow improvement opportunities identified when completing the SLR process. • Facilitates change and supports the CDI team through change management processes. • Actively engages in advancing the CDI practice throughout the UH enterprise. • Actively engages in department and/or enterprise-wide committee. • Performs other duties as assigned. Complies with all policies and standards. For specific duties and responsibilities, refer to documentation provided by the department during orientation.

• Ensures documentation is accurate and complete by performing timely medical record review and determination of code assignment by applying clinical and/or coding expertise to identify opportunities for improved or clarified documentation that accurately reflects the patient. • Direct and timely follow-up with clinical providers to ensure requested clarification is provided. • Responsible and accountable for expanding CDI and coding knowledge (keeping up to date on latest research, technology, treatment modalities, etc.) • Actively engages in educating physicians and other clinical care providers regarding clinical documentation in a variety of formats including participation in clinical rounding, service line focused education sessions and one to one case specific feedback. • Applies knowledge of health care workflows in order to work collaboratively with medical staff and other health care team members to improve the overall accuracy and comprehensiveness of medical record documentation, with focus on ensuring accurate reporting of quality outcomes. • Meets established operational and productivity standards. Consistently meets productivity, quality, and AHIMA ethical standards.

• Serve as an advisor and expert resource for providers to improve the accuracy of clinical documentation to support patient complexity, risk profiles and appropriate E/M levels • Assist providers in identifying clinically relevant information and capturing the clinical documentation needed to accurately reflect patient acuity • Focus on the recapture and identification of chronic conditions reflected in Hierarchical Condition Categories (HCCs) • Complete pre-visit and post-claim reviews as well as providing clear communication and education to providers on their documentation, coding and billing practices • Coordinate with colleagues from the CDI Program or other members of the organization regarding education and training geared towards improving clinical documentation