Job Description

Educate and support physicians and PB coders in accurate, complete, and compliant clinical documentation and coding practices by interpreting patient medical records, provide targeted feedback, and promote adherence to regulatory guidelines resulting in appropriate reimbursement.

• Serves as the primary source of contact and resource for physicians and APP’s with regard to clinical documentation and medical coding for patient care services.

• Develops tools to assist providers with efficient, effective documentation and accurate coding.
• Identifies documentation trends to be shared with the Physician Champion to allow for clinician education.
• Provides group and one-on-one education for faculty, APPs, and house officers, as needed.
• Prepares case and specialty specific documentation examples and power point presentations to be shared at department meetings.
• Orients new physicians with regards to the coding department's role in the revenue cycle and prepares training material for coding related physician education.
• Maintains a consistent coding operations orientation program and reports the coders progress to Coding Leadership throughout the orientation and training processes.
• Performs chart reviews for the purpose of providing feedback to individual providers and coders.
• Conducts, tracks, and communicates provider chart reviews.
• Prepares Coder/Provider review results for report to leadership.
• Prepares educational material based on audit results and reviews material with the coding staff, providers and other key stakeholders impacted.
• Assists coding leadership with training and/or development to improve team member performance.
• Assists Coding Supervisor with reviewing and responding to external coding audits.
• Acts as a subject matter expert regarding official coding guidelines.
• Monitors changes to coding methodologies, official coding guidelines, regulatory standards, reimbursement schemes
• Maintains current knowledge base in all aspects of CPT, HCPCS and ICD -10-CM coding.
• Keeps abreast of all current billing and coding rules and regulations affecting government and non-government payers and disseminates information to appropriate individuals as needed.
• Reviews and researches coding/billing issues, including but not limited to, rejection reports and claim denials.
• Performs regular analysis of the impact of coding and clinical documentation on reimbursement and identifies trends and opportunities for improvements.
• Adheres to compliance regulations, the Christ Hospital Code of Conduct, and the Christ Hospital Core Values AAPC Code of Ethics and AHIMA Code of Ethics while performing all duties detailed.

Requires a working knowledge of Medicare regulations on charging and billing practices (UB92 and 1500/HCFA), knowledge of CPT and HCPCS coding, and the ability to read/analyze itemized billing statements, medical records, & lab reports. Critical thinking skills needed to independently conduct Opportunity Assessments in new areas of charging. Must be detailed-oriented and have the ability to work in team environment and work toward team goals. Ability to summarize findings and present for appropriate intervention and education. Proficiency in Microsoft Office applications required. Ability to learn and work with “Charge Capture” software.

EDUCATION: Skills assessment required to determine competency level of coding skills. Associate degree in HIM with RHIT or Certified Coder Specialist-Physician (CCS-P) or Certified Professional Coder (CPC) required.

YEARS OF EXPERIENCE: 5 years related experience in multiple specialties required.

REQUIRED SKILLS AND KNOWLEDGE:

• Demonstrated in depth knowledge of ICD-10 and CPT coding guidelines, medical terminology, anatomy, and physiology.

• Ability to accurately code diagnosis, diagnostic and surgical procedures in multiple specialties with in-depth of knowledge in Evaluation and Management (E/M) coding.

• Strong knowledge of legal, regulatory, and policy compliance issues related to medical coding and documentation.

• Demonstrated effective verbal and written communication skills, including with physicians and groups.

• Research skills including knowledge of automated analysis tools and on-line research tools to resolve complex coding and healthcare issues.

• Demonstrated ability to effectively work within a team environment, using excellent written, verbal, and presentation skills to share audit findings, risk areas, and compliance issues with coders, office managers, physicians, etc.

• Maintains confidentiality and always protects sensitive data.

• Excel Proficiency: Strong Excel skills including data management and data interpretation.

LICENSES REGISTRATIONS &/or CERTIFICATIONS:

Associate’s Degree in HIM with RHIT, or CCS-P, or CPC required.

Other Credentials Required or Preferred: NONE