Coding & Data Quality Specialist

Reporting to the Manager, Coding & Data Quality Specialist, primary role is to improve and maintain the integrity of the coding database and develop/implement various audits and processes to optimize the quality of the coded data for internal and external reporting. The Coding & Data Quality Specialist will train and educate new and existing coding staff, implement newly mandated CIHI and MOHLTC coding initiatives and projects, and act as the primary internal resource for coding queries. The role is also responsible for educating physicians and clinical leaders on coding guidelines and methodologies with a focus on clinical documentation improvement (CDI) practices.

The Coding & Data Quality Specialist will work collaboratively with all stakeholders, including external bodies such as CIHI, MOHLTC, CCO, to ensure Unity Health’s coding practices meet standards while optimizing hospital funding, quality and performance measurement, utilization management and research.

RESPONSIBILITIES:

• Assess data integrity issues and recommend solutions to improve data quality gaps and decrease errors
• Perform regular coding audits on DAD and NACRS to ensure accuracy, consistency and adherence to standards
• In collaboration with Decision Support, reconcile coded data with ancillary systems to ensure appropriate HIG/CMG+/CACS assignment and optimization of Health Based Allocation Model (HBAM) and Quality Based Procedure (QBP) funding
• Support the month-end coding process by developing, analyzing, distributing and validating quality assurance reports
• Perform retrospective chart reviews to ensure complete, accurate and consistent coding and work closely with Clinical Coding Specialists to share findings
• Update coding data quality scorecard on a quarterly basis
• Implement Clinical Documentation Improvement (CDI) processes
• Develop and conduct physician/clinician education programs throughout the organization to improve coding awareness and understanding of coding/abstracting methodologies and its financial impacts on hospital funding (HBAM/QBP) as defined by CIHI and MOHLTC guidelines and principles
• Influence appropriate clinical documentation which reflects the complexity of care provided for our patient population including the capture of comorbid conditions and high cost interventions
• Facilitate relationship building between clinicians and Clinical Coding Specialists
• Support the physician query process by submitting questions, managing responses and results of queries to clarify conflicting and non-specific documentation
• Improve data capture to better reflect quality indicators and patient care outcomes
• Collaborate with programs and committees in the development of appropriate measures and tools to collect data when new mandates are received from the MOHLTC and CIHI
• Develop, implement and maintain training programs and education materials for new and existing staff
• Conduct in-service education sessions and facilitate cross-training of coders
• Act as primary resource for coding queries from team
• Support team on any updates to the Canadian Coding Standards and DAD and NACRS abstracting manuals, coding best practices and organization policies and procedures
• Co-facilitate meetings at the beginning of each fiscal year to review changes as required
• Co-facilitate monthly team meetings with Coding Manager
• Stay informed by participating in on-going educational workshops/courses and establish benchmarking best practices to improve professional knowledge of coding processes
• Serve as subject matter expert for coding inquiries from Decision Support Services, programs, researchers, clinicians and various other disciplines regarding ICD-10-CA/CCI, coding processes and best practices
• Co-mentor Health Information Management student practicums
• Assist with recruitment of new staff
• Provide backup to Manager with CIHI submissions, month-end QA process, 3M system maintenance and upgrades, workload distribution and general operations.
• Code and abstract inpatient and/or outpatient charts as needed for system testing and quality improvement initiatives
• Other duties as assigned by Manager

QUALIFICATIONS AND SKILLS:

• Graduate from an accredited Health Information Management program required.
• CHIM Certified in good standing with the Canadian College of Health Information Management required.
• Bachelor's degree in Health Information Management, Health Administration or other health discipline preferred.
• Minimum 5 years coding and abstracting experience with Discharge Abstract Database (DAD) and National Ambulatory Care Reporting System (NACRS) required, preferably within a tertiary or teaching facility.
• In depth knowledge of ICD-10-CA/CCI classification system, CMG+/HIG/CACS grouping methodologies.
• Experience with hospital funding models (HSFR, HBAM, QBPs) required
• Experience with coding/abstracting application software; 3M HDM and Code finder preferred.
• Excellent knowledge of Microsoft Office applications.
• Ability to work independently, prioritize multiple work assignments/timelines and manage stakeholder expectations.
• Excellent analytical and problem solving skills with attention to detail a must
• Excellent oral and written communication skills.
• Proven interpersonal skills with the ability to be an effective team player.

NOTE: This is a hospital network position that will have multi-site responsibility.

Unity Health Toronto is committed to creating an accessible and inclusive organization. We strive to provide a recruitment process that is barrier-free and in compliance with the Accessibility for Ontarians with Disabilities Act (AODA) and the Ontario Human Rights Code. We understand that you may require an accommodation at any stage of the recruitment process. When you are contacted, please inform the Talent Acquisition Specialist and we will work with you to meet your accommodation needs. We want to emphasize that all accommodation requests are handled with the utmost confidentiality, respecting your privacy and dignity.