Job Description

Riverland Community Health is a Federally Qualified Health Center in St. Paul, where patients receive community-based Family Practice medical care in addition to mental health, dentistry, social work and other integrated services. When joining RCH, you become part of a diverse, inclusive, and welcoming team who are dedicated to serving our patients and pursuing our mission to deliver excellent healthcare for all and training for the providers of tomorrow.

JOB SUMMARY:

The Medical Coding Specialist / Provider Educator is responsible for the review of medical records, notes, dictation and other related documentation to ensure the accurate and timely submission of charges for professional services provided by physicians and other providers as well as diagnoses for clinic services. The Medical Coding Specialist / Provider Educator is also responsible for conducting coding audits, providing education and communication of process improvements on inpatient and outpatient coding. Monitor the accuracy and efficiency of the documentation and coding and provide tools and resources for improving accuracy or implementing changes. Implement an effective education and communication process for all coding and monitor the accuracy and efficiency of the documentation and coding staying current with new regulations and changes.

ESSENTIAL FUNCTIONS:

Administrative Duties (80%):

• Review patient medical records, clinician notes, and other documentation in the electronic medical record and/or paper record to determine the appropriate code for diagnosis, procedures, treatments, and encounters in accordance with RCH policies and current ICD-10-CM guidelines.
• Utilize available encoder and other coding resources to determine appropriate CPT code including Evaluation and Management (E&M) codes for professional services.
• Ensure maximum efficiency and reimbursement for properly documented services and work directly with providers to correct unclear or improperly documented encounters.
• Maintain working knowledge of ICD-9/ICD-10, CPT coding requirements and principles, governmental regulations, protocols, third party requirements, and all relevant state and federal billing and documentation guidelines.
• Maintain an understanding and apply knowledge of National Correct Coding Initiatives (NCCI), Local Coverage Documents and National Coverage Documents (LCD/NCD) directives, Medically Unlikely Edits (MUEs), applying knowledge of applicable regulatory requirements and institutional guidelines to select appropriate codes and modifiers.
• Chart auditing, data analysis of coding practices, provider and staff education.
• Maintain current knowledge on CMS regulations. Research new practices and methods of coding and changes as needed.
• Collaborate with other members of the business office to maintain a smooth workflow and identify coding issues and changes.
• Identify, document and communicate interference or issues with any communications leaving the site.
• Conduct thorough investigations of concern or issues to correct issues in a timely manner.
• Maintain/update coding procedures and guidelines.
• Maintain strict confidentiality; adheres to all HIPAA guidelines/regulations.

Educational Duties (20%):

• Create presentations, develop educational material, handbooks and other training materials.
• Audit current coding practices and work directly with coders and providers to provide feedback and education as needed.
• Provide communication, education and training to providers.
• Provide on-the-spot education as needed.

Perform other tasks as assigned.

Requirements

KNOWLEDGE, SKILLS AND ABILITIES:

• Knowledge of medical terminology
• Knowledge of billing CPT and ICD coding required
• Proficient in Epic Electronic Health Record and Billing Systems.
• Intermediate or advanced computer skills and ability to produce complex documents and spreadsheets using word processing, spreadsheets, graphic design, desktop publishing, database management and software.
• Ability to identify variances in documentation and correct assignment of CPT/ICD10 codes and educate staff of corrections.
• Strong quantitative, analytical and technical skills with careful documentation and attention to detail.
• Excellent written and verbal communication abilities.
• Ability to work independently or in a team.
• Ability to identify issues, problem solve and find resolution.
• Ability to analyze patient accounts.
• Demonstrate sound judgement and decision-making abilities.
• Ability to prepare and maintain detailed records, files, reports and other correspondence.
• Ability to establish and maintain effective communication with a broad array of people from different departments.
• Ability to perform the job in accordance with Riverland Community Health’s Standards of Business Conduct, which include compliance, ethics and integrity, confidentiality, protection of assets and avoidance of conflicts of interest and inappropriate business relationships.
• Excellent time management skills with the ability to prioritize workflow and meet stringent deadlines.

EDUCATION/EXPERIENCE:

• High School Graduate or GED is required.
• Bachelor’s degree in education, Business Administration, Healthcare Administration or related field is preferred.
• 1-3 years’ coding experience with coding certification (CPC or CCS) is required.
• 1-3 years’ experience in coding education or regulatory education or similar area is required.
• 3-5 years’ experience with strong written and verbal professional communication skills is required.
• A community clinic or Federally Qualified Health Center experience is preferred.

CERTIFICATES, LICENSES, REGISTRATIONS:

CPC (Certified Coding Profession) or ACA (Certified Coding Associate) certification required.

PHYSICAL DEMANDS:

• Prolonged periods of sitting at a desk and working on a computer.
• Must be able to lift up to 15 pounds at times.

SUPERVISORY RESPONSIBILITIES:

None

WORK ENVIRONMENT:

Work is performed in a clinic office environment. Contact with staff, patients and outside agencies. Possible exposure to communicable disease and medical preparations common to clinic environment.

A summary of our benefits include but are not limited to: health, dental, vision, HSA, FSA, basic life insurance, voluntary additional life insurance, spousal and child insurance, long-term disability, and a 403b retirement plan.

In addition, job offers made during flu season are conditioned on the candidate receiving the annual flu vaccination before their start date.

RCH is an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status.

Compensation is $26.00 to $36.00 hourly DOE.