Responsibilities
Follows established protocols, selects and reviews a percentage of records to assess coding documentation, billing and/or reimbursement practices for compliance with all regulations for federal and state agencies, third-party payers, and organization policy.
Communicates audit progress and findings by preparing reports and providing information to the Compliance Officer, Chief Medical Officer, and Chief Quality Officer as applicable.
Investigates, evaluates, and identifies opportunities for improvement, recognizes their relative significance in the overall system, and provides guidance to departments regarding internal controls.
Develops and maintains professional skills and knowledge through attendance at relevant conferences, seminars, and other educational programs, participation in professional organizations, and review of current literature.
Conducts billing and coding training, including provider training, as they relate to billing, coding, and documentation compliance.
Assists with the development and review of policy and procedures and provides necessary staff support and resources to develop and maintain policies to ensure compliance with designated federal and state laws, regulations, and policies.
Assists the Compliance Officer in developing and implementing education and training materials related to documentation and coding, as well as regulatory compliance.
Supports the Compliance Officer in the review of, and response to, documentation and coding reviews and quality and program audits, compiling information for submission to the QA/QI Committee and Board of Directors.
Participates in monitoring reviews and audits conducted by various regulatory agencies.
Analyzes provider documentation to assure the appropriate Evaluation and Management (E&M) levels are assigned using the correct CPT code.
Fields coding questions from clinical and ancillary staff.
Other duties as assigned.
Requirements
2+ years of experience in health care
Medical coding certification required (CPC, CCS-P, COC), preferred minimum 1-year experience actively using certification.
Advanced knowledge of medical terminology, techniques and surgical procedures; anatomy and physiology, and major disease processes.
Excellent understanding of HIPAA regulations.
Knowledge of Epic EMR preferred.
Hard Skills
medical coding
billing compliance
documentation compliance
CPT coding
Evaluation and Management (E&M) levels
internal controls
policy development
auditing
training development
data analysis
Soft Skills
communication
investigative skills
organizational skills
guidance
collaboration
problem-solving
attention to detail
reporting
adaptability
professional development
Certifications & Qualifications
CPC
CCS-P
COC
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