Position Purpose This position is responsible and accountable for initial and ongoing education of providers and/or coding staff on key revenue cycle topics, including but not limited to coding, documentation, billing policies, and regulatory compliance in regard to facility (HB) and professional (PB) coding. As such, this position takes a significant role in developing the training and curricula necessary to ensure physicians and/or staff reach and maintain a desired level of coding and documentation proficiency across all care settings.
This position is also responsible for ensuring the accuracy of information in these processes is maintained through the conducting and analysis of periodic audits—and, if accuracy is not at the expected level, this individual is responsible for the reeducation and training of physicians and/or staff to ensure these departments are meeting their targets. Additionally, this position is responsible for serving as a figurehead of knowledge as it relates to all coding systems in use (ICD-10-CM & PCS, CPT HCPCS); CMS, federal, and state coding regulations; and third-party reimbursement requirements.
Nature and Scope Incumbent is responsible for conducting and coordinating audits of provider's professional documentation to ensure that correct services are being billed and provide education and consistent feedback to the provider's using identified communication tools. The major challenge of this position is coordinating and managing the provider's auditing and education schedules to ensure compliance of assigned codes, charges, and quality documentation.
Incumbent is responsible for reviewing coded encounters and related documentation to ensure documentation supports the level billed by providers. This position ensures that physician services are coded accurately based on Coding and Reporting Guidelines. Identifying educational/learning needs, planning, evaluating, and implementing educational programs to enhance documentation and coding practices across the organization.
Serve as a liaison between the providers, clinical staff, and coders. Demonstrates attention to detail to minimize coding errors, legitimately optimize reimbursement and ensure accurate billing. The incumbent is responsible for reviews and training across inpatient and outpatient facility accounts, inpatient, outpatient and professional (profee) accounts and overall documentation from providers on all accounts.
Specific
- include:
- Investigate, evaluate, and identify opportunities for improvement and provide guidance and counsel to providers with face-to-face and/or virtual meetings.
- Identify and review areas requiring attention, performing special reviews/investigations as requested, share this information with leadership and provide one-on-one education with the provider in a timely manner.
- Collect and analyze data, submit reports as assigned and monitor monthly reviews to ensure that they are completed timely.
- Report/record all documentation and coding issues that require follow-up reviews to coding manager.
- Be aware of what is happening in clinic/department and the organization by attending clinic/department meetings, reading e-mails/in-basket messages and regularly checking information on the organization’s intranet site.
- Balance team and individual responsibilities; be open and objective to other’s views; give and welcome feedback; contribute to positive team goals; and put the success of the team above own interests.
- Perform other duties at the request of various departmental leadership groups to facilitate the smooth and effective operations of the organization.
- Research coding inquires and be a resource for providers, clinical, billing and coding staff.
- Investigate, evaluate, and identify opportunities for improvement and provide guidance and counsel to providers, clinical staff, coding staff, and/or billing staff by setting up small group meetings or training sessions.
- Develop, update, and implement coding department/provider newsletters, education, reference documents.
- Proactively identify areas of opportunity to improve coding quality based on audit feedback, coder questions, physician escalations, denial meetings, and other platforms and plans coder education accordingly.
- Demonstrate the attention to detail to minimize coding errors, legitimately optimize reimbursement and ensure accurate billing.
- Serves as a liaison point of contact for clinical coding inquiries and communication for professional billing revenue cycle and providers.
- Seeks to establish collaborative relationships with physician leaders, clinical providers, Compliance, Revenue Cycle, and administrative leadership in the support of coding education and documentation adequacy.
- Assists with claim denial reports and trend reviews to ensure optimal reimbursement and identify education and compliance opportunities.
- Analyzes billing trends to identify areas of non-compliance and prepares regular reports on review findings to appropriate committees.
- Assists in the development of corrective action plans and participates in compliance investigations as needed.
- Manages special projects individually or in collaboration with other departments.
- Track coding quality and documentation improvements to measure organizational growth and support of clinical documentation improvement initiatives.
- Always maintains confidentiality of sensitive information. Incumbent must have skill set to:
- Address appeals and review needed information for insurance denials to facilitate expedient resolution and reimbursement.
- Participates in mandated Medical Record Review processes.
- Interprets and applies American Hospital Association (AHA) Official Coding Guidelines to articulate and support appropriate principal, first-listed, secondary diagnoses and procedures.
- Knowledge of discharge disposition and reimbursement outcomes.
- Adherence to Health Information Management (HIM) Coding policies.
- Adherence to The Joint Commission (TJC) and other third-party documentation guidelines in an effort to continually improve coding quality and accuracy.
- Responsibility for maintaining coding certification and continuing education.
- Participates in performance improvement initiatives as assigned. KNOWLEDGE, SKILLS & ABILITIES Expert knowledge and specific details of coding conventions and use of coding nomenclature consistent with CMS’ Official Guidelines for Coding and Reporting ICD-10-CM coding. Expert knowledge of Anatomy and Physiology of the human body, Pharmacology, Disease Pathology, and Medical Terminology in order to understand the etiology, pathology, symptoms, signs, diagnostic studies, treatment modalities, and prognosis of diseases and procedures performed. Excellent communication and interpersonal skills including 1:1 mentoring and large group presentations. Accurate translation of written diagnostic descriptions to appropriately and accurately assign ICD-10-CM diagnostic codes and procedural codes to obtain optimal reimbursement from all payer types, including Medicare/Medicaid, private and commercial insurance payers. Knowledge of clinical content standards. Ability and knowledge of the appeal process to ensure accurate reimbursement. Utilize critical thinking and problem-solving abilities. Ability to work well with others. Uphold a strong work ethic characterized by honesty and dependability. Demonstrate personal time management skills, including organization, prioritization, and multitasking. Adherence to company policies, procedures, and directives. This position does not provide patient care Disclaimer The foregoing description is not intended to be, and should not be construed as, an exhaustive list of all responsibilities, skills, efforts, or working conditions associated with the job. It is intended to be an accurate reflection of the general nature and level of the job.
Requirements - Required and/or Preferred Name Description
Ability to read, write, speak, and understand English sufficiently to perform job duties safely and effectively. High school diploma or equivalent required; bachelor’s degree in health information management, business administration, healthcare administration, or related field preferred
A minimum of 5-8 years of previous facility and/or pro-fee coding experience required. A minimum of 2 years of previous experience performing, analyzing, and providing feedback on physician documentation and coding audits required. Teaching experience for a variety of comprehension levels preferred.
License(s): None Certification(s): CPC, CCS and/or CCS-P required at the time of hire. (Excludes apprenticeship classification) Computer / Typing: Must be proficient with Microsoft Office Suite, including Outlook, PowerPoint, Excel, Teams, and Word and have the ability to use the computer to complete online learning requirements for job-specific competencies, access online forms and policies, complete online benefits enrollment, etc.
Day shift · 8-5