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Job Location (Full Address):

601 Elmwood Ave, Rochester, New York, United States of America, 14642

Opening:

Worker Subtype:

Regular

Time Type:

Full time

Scheduled Weekly Hours:

40

Department:

500009 Utilization Management

Work Shift:

UR - Day (United States of America)

Range:

UR URG 110

Compensation Range:

$61,000.00 - $85,400.00

Responsibilities:

Collaborates with coding and clinical documentation integrity management, plays a critical role in ensuring the accuracy, completeness, and compliance of coding practices within the organization. Develops and delivers coding education programs, conducts regular coding audits, analyzes coding data to identify trends and areas for improvement, and serves as a subject matter expert on coding guidelines and regulations. Fosters a culture of continuous learning and coding excellence among our coding staff and clinical documentation team for the accurate and timely assignment of diagnostic and procedural codes for complex patient encounters. Provides expert-level coding guidance, education, and quality review for all coding staff. Acts as a subject matter expert, ensuring coding compliance, data integrity, process improvements, system implementations and upgrades, and optimal reimbursement while supporting the professional development of the coding team.

Essential Functions:

• Develops, implements, and delivers comprehensive coding education programs for new hires and existing coding staff, covering ICD-10-CM/PCS, CPT, HCPCS, DRG, and APC methodologies. Provides ongoing education on updates to coding guidelines, regulatory changes, and payer requirements. Creates educational materials, presentations, and job aids to support learning and reference. Conducts one-on-one coaching and mentoring sessions for coders to address specific areas for improvement. Collaborates with clinical documentation team to provide education to clinicians on documentation best practices that support accurate coding. Serves as a resource to the coders, clinical documentation specialists, providers, ISD, Compliance, and other billing departments.
• Performs regular internal coding audits (pre-bill and post-bill) to assess coding accuracy, compliance with official guidelines, and adherence to organizational policies. Identifies coding discrepancies, documentation deficiencies, and opportunities for revenue integrity improvement. Provides constructive feedback to coders based on audit findings and monitors progress on corrective actions. Assists in preparing for external audits and responding to audit requests.
• Analyzes coding data, audit results, and denial trends to identify patterns, root causes of errors, and areas requiring focused education or process improvement. Generates reports on coding accuracy, productivity, and educational effectiveness for department leadership. Monitors key performance indicators (KPIs) related to coding quality and compliance.
• Participates in the development and revision of coding policies, procedures, and guidelines to ensure compliance with regulatory standards and industry best practices. Stays current with changes in coding regulations (e.g., CMS, OIG), payer policies, and industry standards. Serves as a subject matter expert in coding.
Other duties as assigned.

Minimum Education & Experience:

• Bachelor's degree in Health Information Management, Healthcare Administration, Nursing or a related healthcare field and 4 years of inpatient coding experience in an acute care setting required.
Or equivalent combination of education and experience.

Knowledge, Skills & Abilities:

• Expert Coding Knowledge, including in-depth understanding of ICD-10-CM/PCS, CPT, HCPCS, MS-DRGs, APR-DRGs, APCs, and NCCI edits preferred.
• Strong knowledge of HIPAA, CMS regulations, OIG guidelines, and other relevant healthcare compliance standards preferred.
• Ability to analyze complex data, identify trends, and draw actionable conclusions preferred.
• Excellent written and verbal communication skills, with the ability to present complex information clearly and concisely to broad audiences preferred.
• Proven ability to develop effective training materials and deliver engaging educational sessions preferred.
• Proficient in Electronic Health Record (EHR) systems, coding encoder software, and Microsoft Office Suite (Word, Excel, PowerPoint) preferred.
• Strong ability to build rapport, collaborate effectively, and provide constructive feedback preferred.
• Meticulous attention to detail in auditing and documentation review preferred.
Proactive approach to identifying and resolving coding and documentation challenges preferred.

Licenses and Certifications:

• Certified Coding Specialist (CCS) required OR
• Registered Health Information Administrator (RHIA) required OR
• Registered Health Information Technician (RHIT) upon hire required.

The University of Rochester is committed to fostering, cultivating, and preserving an inclusive and welcoming culture to advance the University’s Mission to Learn, Discover, Heal, Create – and Make the World Ever Better. In support of our values and those of our society, the University is committed to not discriminating on the basis of age, color, disability, ethnicity, gender identity or expression, genetic information, marital status, military/veteran status, national origin, race, religion, creed, sex, sexual orientation, citizenship status, or any other characteristic protected by federal, state, or local law (Protected Characteristics). This commitment extends to non-discrimination in the administration of our policies, admissions, employment, access, and recruitment of candidates, for all persons consistent with our values and based on applicable law.