The ICD-10-CM/PCS Coding Consultant is responsible for identifying, researching and developing International Classification of Diseases10th Revision (ICD-10-CM) and International Classification of Diseases, 10th Revision, Procedure Classification System (ICD-10-PCS) material for Coding Clinic for ICD-10-CM and ICD-10-PCS to update throughout the United States. Research and draft responses to requests for ICD-10-CM and ICD-10-PCS coding advice received by the Central Office; assist in development of background materials for Editorial Advisory Board review. Known as an expert that contributes to publications in Coding Clinic for ICD-10-CM and ICD-10-PCS which is recognized by the Centers for Medicare and Medicaid Services (CMS) as the national authority on coding issues.
Coding Clinic for ICD-10-CM and ICD-10-PCS is the only official source of ICD-10-CM and ICD-10-PCS coding advice. The coding advice and coding guidelines published in Coding Clinic are approved by the Centers for Disease Control and Prevention’s (CDC) National Center for Health Statistics, American Hospital Association (AHA), CMS, and the American Health Information Association (AHIMA). The four Cooperating Parties consult with an expert panel of physicians and are responsible for the development of official coding guidelines for national reporting.
Describe the key responsibilities of this position. List and describe each essential function on its own line using the numbered list option on the Home tab in Microsoft Word.
Research and draft responses to requests for ICD-10-CM and ICD-10-PCS coding advice received by the Central Office, so that consistent and meaningful data is reported in all health care settings in accordance with established coding guidelines.
Review and analyze comments on drafts of coding responses to ensure accuracy and consistency of Central Office advice.
Maintain a database of coding responses, retrievable by text or numerical search to ensure consistency in drafting responses to similar questions previously answered.
Contribute to the quarterly newsletter published by the Central Office on ICD-10, the official clearinghouse for ICD-10-CM and ICD-10-PCS coding questions.
Identify potential agenda items for the Editorial Advisory board from responses drafted, and develop agenda materials to address these issues. This process includes clinical research, discussions with clinical specialists, and use of other sources to provide sufficient background information for the board's deliberations.
Serve as the AHA ICD-9-CM, ICD-10-CM and ICD-10-PCS expert and maintains the integrity of the office by continually providing reliable and accurate coding advice.
Describe how success in performing the functions will be measured. Reference work unit goals or areas where this positions aligns to the AHA Management Dashboard or where this role may have alignment with AHA’s strategic performance commitments.
Recognized by AHA members and subscribers as an expert in the structures and use of the classification systems and health care data for ICD-10-CM and ICD-10-PCS.
Respond to 40-50 requests for coding advice per month within a 30-day turn around.
Acceptance of responses to questions by submitters as well as the Editorial Advisory Board for Coding Clinic for ICD-10-CM and ICD-10-PCS and appropriateness of coding issues identified for review and publication in the newsletter.
Provides correct advice that is relied upon by hospitals, health systems, consultants, physicians, auditors, nosologists, researchers, quality improvement organizations (QIOs), coding instructors, compliance officers and payers, as well as the Office of the Inspector General to ensure that national coding standards are followed.
Regularly identifies and develops agenda items for the Editorial Advisory Board.
Required Education: Bachelor's Degree
Desired fields of study: Health Information Management
Required Experience: 3-5 years
Desired area/fields(s) in which experience was obtained:
Minimum 3 years of experience with ICD-10-CM and ICD-10-PCS within a hospital environment is required.
Previous experience in a role similar to a coding supervisor, lead coder, coding trainer/educator, coding auditor or coding compliance professional providing guidance and expertise related to ICD-10-CM and ICD-10-PCS is required.
Must have passed Registered Health Information Administration, or Registered Health Information Technician examination.
AHIMA approved trainer in ICD-10-CM and ICD-10-PCS is a plus.
Describe the general or specific field of knowledge required.
Advanced knowledge of ICD-10-CM and ICD-10-PCS systems.
Recognized as a lead to others related to clinical coding.
Knowledge of Inpatient Medicare Prospective Payment System (MS-DRGs), and other prospective payment classifications that rely on ICD-10-CM and ICD-10-PCS.
Familiarity with clinical content, financial and clinical systems; fundamentals of medical science; and the structure, content, uses, strengths, and weaknesses of various clinical data classification schemes, other coding classifications, data sets, and DRGs.
Describe the technical, hardware, and software knowledge required.
Advanced computer and Microsoft Office (Word, Outlook, Excel) skills are required.
Ability to learn new software and technology is required.
Emboldened competencies are AHA’s core competencies.
Collaborates and builds relationships
Communicates and influences broadly
Demonstrates adaptability and self-awareness
Executes and delivers results
Demonstrates thought leadership
Focuses on customers and members
Leverages knowledge and expertise
Maximizes personal and team performanc
Provides supportive leadership
Required Travel: Less than 10% travel
The conditions the worker will be subject to in this position.
Ability to understand, remember, and apply oral and/or written instructions or other information.
Ability to understand, remember, and communicate routine, factual information.
Ability to understand complex problems and to collaborate and explore alternative solutions.
Ability to understand opposing points of view on highly complex issues and to negotiate and integrate different viewpoints.
Ability to organize thoughts and ideas into understandable terminology.
Ability to organize and prioritize own work schedule.
Ability to organize and prioritize work schedules of others.
Reasoning and Decision Making
Ability to apply common sense in performing job.
Ability to make decisions which have moderate impact on immediate work unit.
Ability to make decisions which have significant impact on the immediate work unit and monitor impact outside immediate work unit.
Ability to make decisions which have significant impact on the department’s credibility, operations, and services.
Ability to understand and follow basic instructions and guidelines.
Ability to complete routine forms, use existing form letters and/or conduct routine oral communication.
Ability to compose letters, outlines, memoranda, and basic reports and/or to orally communicate technical information.
Ability to communicate with individuals utilizing a telephone; requires ability to hear and speak effectively on phone.
Ability to express or exchange ideas by means of the spoken word, communicating orally with others accurately, loudly, and quickly.
Ability to make informal presentations, inside and/or outside the organization. Speaking before groups.
Ability to compose materials such as detailed reports, work-related manuals, publications of limited scope or impact, etc., and/or to make presentations outside the immediate work area.
Ability to formulate complex and comprehensive materials such as legal documents, authoritative reports, official publications of major scope and impact, etc., and/or to make formal presentations.
No mathematical ability is required.
Ability to count accurately.
Ability to add, subtract, multiply, divide and to record, balance, and check results for accuracy.
Ability to compute, analyze, and interpret numerical data for reporting purposes.
Ability to compute, analyze, and interpret complex statistical data and/or to develop forecasts and computer models.
The American Hospital Association (AHA) is the national organization that represents and serves all types of hospitals, health care networks, and their patients and communities. Close to 5,000 hospitals, health care systems, networks, other providers of care and 37,000 individual members come together to form the AHA.
Through our representation and advocacy activities, AHA ensures that members'... perspectives and needs are heard and addressed in national health policy development, legislative and regulatory debates, and judicial matters. Our advocacy efforts include the legislative and executive branches and include the legislative and regulatory arenas.
Founded in 1898, the AHA provides education for health care leaders and is a source of information on health care issues and trends.