Status: Exempt A Brief Overview Provides CPT and ICD-10 codes for Professional outpatient services. Provides ongoing Physician and Non-Physician Practitioner (NPP) coding and compliance education. Performs audits and Physician and NPPs services.
Completes coding audits and education on a regular basis as assigned by leadership. Presents group education on coding to providers, clinic staff and coders as appropriate. Must have skillset to prepare coding materials per regulatory guidelines in a format understandable to providers and clinical teams.
Must stay informed of most recent regulatory guidelines and educate appropriate teams. Education Qualifications High School Diploma / GED Required Experience Qualifications 5 years Multi-Specialty Coding Experience Required Skills and Abilities Thorough understanding of medical terminology, anatomy, CPT and ICD-10 coding with ability to apply regulatory coding guidelines across multiple specialties. (Required proficiency) Licenses and Certifications Certified Coding Specialist - CCS Required or Certified Professional Coder - AAPC Required Certified Professional Medical Auditor - AAPC CPMA Required Certified Professional Medical Auditor - AAPC CPMA Required
Maintains a working knowledge of CPT-4 and ICD-10 coding principles, governmental regulations, protocols and third party requirements regarding documentation and billing for multiple specialties. Serves as a resource with regard to rules and regulations for utilization to ensure compliant reimbursement. Coordinates and conducts inpatient and outpatient chart reviews for professional services to ensure compliance with coding and documentation guidelines and all governmental rules and regulations.
Develops and maintains a close working relationship with the physicians. Advanced Practice Providers and staff to ensure understanding of documentation and coding guidelines which will result in more accurate coding. Provides ongoing educational sessions as appropriate to providers, clinical and coding staff as appropriate.
Code CPT and ICD-9/ICD-10 on assorted services as assigned by Director. Review claim denials for trends. Educates staff and providers on coding issues identified.
Responds to outside audit requests from 3rd party payors as assigned by Director. Maintains audit schedules/finings for all professional audits. Provides orientation of office and hospital coding and compliance regulations to all new Physician, APP and Clinical Staff as appropriate.
Provide education and follow up discussions as deemed appropriate. Performs Coding audits for Professional Coding Staff and provides education as deemed appropriate. Stays current with regulatory changes and provides notification to appropriate teams.
Commitment to LEAN/Performance Excellence processes established within the coding department and ability to identify process improvements. Constantly contributes to a high level of customer satisfaction and process improvements by adhering to Stormont Vail Health Small Moments, 10 Tenets and Cultural Transformation Initiatives. Travel Requirements 10% Travel to provide education to Physicians/APP's and clinical teams as appropriate.
Required for All Jobs Complies with all policies, standards, mandatory training and requirements of Stormont Vail Health Performs other duties as assigned Patient Facing Options Position is Not Patient Facing Remote Work Guidelines Workspace is a quiet and distraction-free allowing the ability to comply with all security and privacy standards. Stable access to electricity and a minimum of 25mb upload and internet speed.
Dedicate full attention to the job duties and communication with others during working hours. Adhere to break and attendance schedules agreed upon with supervisor. Abide by Stormont Vail’s Remote Worker Policy and will review and acknowledge the Remote Work Agreement annually.
Remote Work Capability Hybrid Scope No Supervisory Responsibility No Budget Responsibility No Budget Responsibility Physical Demands Carrying: Rarely less than 1 hour Crawling: Rarely less than 1 hour Kneeling: Rarely less than 1 hour Lifting: Rarely less than 1 hour up to 25 lbs Reaching (Forward): Rarely less than 1 hour up to 10 lbs Reaching (Overhead): Rarely less than 1 hour up to 10 lbs Repetitive Motions: Continuously greater than 5 hours Sitting: Continuously greater than 5 hours Standing: Rarely less than 1 hour Talking: Frequently 3-5 Hours Walking: Occasionally 1-3 Hours Stormont Vail is an equal opportunity employer and adheres to the philosophy and practice of providing equal opportunities for all employees and prospective employees, without regard to the following classifications: race, color, ethnicity, sex, sexual orientation, gender identity and expression, religion, national origin, citizenship, age, marital status, uniformed service, disability or genetic information.
This applies to all aspects of employment practices including hiring, firing, pay, benefits, promotions, lateral movements, job training, and any other terms or conditions of employment. Retaliation is prohibited against any person who files a claim of discrimination, participates in a discrimination investigation, or otherwise opposes an unlawful employment act based upon the above classifications.