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Coding Education Specialist

Accountable Care Organization

Full Time-Non Exempt

Day shift

M-F

Position Summary: 

 

Under the direction of the coding manager, the Coding Education Specialist is responsible for providing coding education for assigned groups, providers, and coders. The Coding Education Specialist is the documentation and coding liaison to providers and resolves questions as they arise regarding coding and documentation requirements. The individual in this position will partner with Coding Auditors, Lead Coders, Revenue Integrity and the Accountable Care Organization to generate educational opportunities needed to support professional coding, documentation compliance and HCC coding. This includes implementing coding education initiatives to improve the accuracy, integrity and quality of patient data, to ensure minimal variation in coding practices and improve the quality of physician documentation to support code assignments.

Essential Duties

·         Review physician practice and hospital E&M patient records to ensure that they contain proper documentation that supports an accurate and compliant E&M level in regards to CMS Documentation Guidelines for CMHC physician practices.

·         Utilize review tools to monitor the accuracy of Physician E&M coding, documentation gaps and outpatient/inpatient billing.

·         Provide support, education and training related to, quality of documentation, level of service and diagnosis coding consistent with established coding guidelines and standards.

·         Analyze and report E&M review findings indicating recommendations and actions taken to improve documentation and coding accuracy.

·         Identifies focus areas of improvement for each provider based on medical record reviews and KPI data.

·         Provides on-site coding and documentation education and feedback

·         Performs regular rounding at sites and departments to provide adequate on-site support.

·         Queries Physicians/Providers prompted by Physician Coding Department Coders to assist in resolving coding and documentation questions.

·         Relays any coding changes, feedback, and education to Physicians/Providers as appropriate.

·         Attends and provides coding and documentation information, as requested, to Physician/Provider and/or Clinic/Site Department meetings.

·         Under the Direction of Coding leadership -Develops Physician/Provider specialty regular reports to continually educate and communicate updates.

·         Communicates Physician/Provider new services to Physician Coding team and Revenue Cycle leadership.

·         Identifies and/or prompts documentation improvement as well as charge capture opportunities.

·         Maintains current knowledge of Medicare, Medicaid, and other regulatory requirements pertaining to nationally accepted coding policies and standards.

·         Other duties as assigned.

 

Technology

·         Seek and recommend new information technology solutions and or manual changes that support departmental functions.

·         Work collaboratively with departmental personnel to implement systems and process changes aimed at improving performance.

·         Ensure compliance with outside regulatory requirements are documented (i.e., CMS regulations, Managed Care contract terms)

 

Management Reporting and Monitoring

·         Review and analyze on-going KPI's based on computer generated data and manual reports.

·         Utilize departmental work plans to monitor initiative and project goals, progress, and outcomes.

 

Professional Development

·         Attend local and regional conferences/seminars to remain current in supporting the needs of the organization.

·         Review industry publications to maintain knowledge base and stay current on best practice solutions.

·         Maintain current knowledge of regulatory developments involving agencies (CMS, AHA, DHS, and Joint Commission.)

·         Maintain certifications as applicable.

·         Maintain membership with professional associations (AHIMA, AAPC etc.)

 

Communication 

·         Maintains awareness of verbal/ nonverbal communication in interactions with staff, other departments, physicians (providers), patients, and families as required.

·         Maintains patient, staff and hospital confidentiality in all communication interactions: written, verbal, electronic and digital.  

 

Customer Service 

·         Displays positive attitude. Treats others with honesty and respect. Speaks positively in all customer interactions internal and external. 

 

Education and Experience

·         Bachelor's degree required, or four (4) years related revenue cycle experience in lieu of, and

·         Two (2) years of professional coding experience with physician practice E&M services.

·         AHIMA (CCA, CCS, CCS-, or RHIT); AAPC (CPC, CPC-A, CPC-H, CPC-H-A, or one of the relevant AAPC specialty-specific coding credentials required.

Knowledge, Skills, and Abilities

·         Detailed knowledge of privacy and security regulations, confidentiality / HIPAA

·         Proficient in ICD10CM, CPT and HCPCS coding, policy and procedures based on physician practices. Strong knowledge of Evaluation and Management (E&M) Coding and CMS Documentation Guidelines and Hierarchical Condition Categories

·         Expertise with regulations and accreditation standards, knowledge of specific state and federal requirements and standards.

·         Working knowledge of Medical Record, Financial Services and Healthcare Application technology. 

·         Demonstrated experience in diagnosing, evaluating and developing corrective actions for problems in operations. 

·         Able to effect collaborative alliances and promote teamwork.

·         Ability to ensure a high level of employee, patient, visitor, and external stakeholder satisfaction.

·         Effective organizational, planning, controlling, scheduling and project management abilities.

·         Effective managerial and administrative abilities as applied to the management of multiple projects.

·         Ability to positively influence change. 

·         Excellent communications skills, both oral and written. 

·         Demonstrated ability to work well with diverse people, excellent human relation skills.

·         Flexible and able to react to ever changing priorities.

 

PHYSICAL ENVIRONMENT

Most duties do not generally present an occupational risk, however, failure to follow standard procedures and safety rules may expose the employee to potential injury e.g. falls on slippery floors, etc. 

PHYSICAL REQUIREMENTS

Must be in good physical condition to meet the demands of an active position including moderate walking, sitting, standing, and twisting and moderate hand/wrist motion.