REPORTING RELATIONSHIPS/SUPERVISORY RESPONSIBILITIES

This position reports to the Director, Professional Coding, Audit & Education has no direct reports.

POSITION SUMMARY

Conducts audits of physician/provider documentation and coding for office and surgical procedure encounters. Develops and delivers education to physicians, providers, office/department support staff and revenue cycle staff on compliant documentation and coding practices, including regulatory changes or updates. Reviews medical record documentation and claims data to ensure compliance with CMS and payer guidelines and regulations.

ACCOUNTABILITIES

*All duties listed below are essential unless noted otherwise*

1. Assist in coordinating and developing an educational plan that encompasses accurate documentation, coding, and billing procedures to obtain appropriate reimbursement.

2. Provide regularly scheduled education for providers and staff on appropriate coding and billing in the professional environment, including ICD-10, CPT and HCPCS coding.

3. Design educational documents and tools to improve the level of knowledge of documentation requirements and CPT and ICD-10 coding guidelines for providers and staff.

4. Research and communicate government and private insurance carrier coding/billing policies and guidelines to appropriate providers and staff.

5. Perform audits to determine documentation compliance and coding/billing accuracy; summarize findings and develop plans to improve outcomes.

6. Review code change requests to determine accurate coding and/or advise coding or billing changes to ensure appropriate reimbursement.

7. Conducts reviews of coding denials or other payer requests; performs appropriate follow up including appeals and corrective actions with departments and staff.

8. Assist in reviewing and updating physician documentation templates and forms consistent with coding/billing guidelines and system policies.

9. Assists with training new staff or other special projects.

10. Perform other duties as assigned.

This position can be worked remote.