Apr 16, 2024

PROFESSIONAL CODING COMPLIANCE SPECIALIST

  • Riverside Healthcare
  • Remote
Full Time (CPC) Certified Professional Coder (CRC) Certified Risk Adjustment Coder (CPMA) Certified Professional Medical Auditor

Job Description

We Are Hiring!

At Riverside, everyday brings new and exciting challenges. You can expect an interesting environment where you’re part of making sure our organization is running optimally and safely, helping keep the community healthy. We provide the kind of paid training and opportunities that long-term careers are built on and we recognize hard workers who strive to make a difference. You will be able to succeed in our close-knit, safety-focused culture working together as a team. The careers we offer are meaningful because the work we do matters. Join us!

FTE: 1.000000

Shift: Days

Location: remote workforce position with hybrid option upon employee-management agreement

 

Summary:

The Professional Coding Compliance Specialist provides revenue cycle support to Riverside Medical Group and its coding team by regularly auditing provider documentation and corresponding coding to ensure correct, complete and compliant practices that fully support diagnoses reported and charges submitted for services rendered, meet regulatory and payor-specific requirements, and accurately describe the patient encounter; providing feedback and education to providers and coders based on audit results, regulatory changes, and industry trends; assisting with orientation of new providers, residents/fellows, and new members of the coding team.

This is a fully remote workforce position with hybrid option upon employee-management agreement

 

Experience/Education Requirements:

  • High school graduate or equivalent required
  • Associate degree in health-related field preferred
  • Formal education in ICD-10-CM and CPT/HCPCS coding principles and assignment maintained by relevant continuing education
  • Minimum three years current ICD-10-CM and CPT/HCPCS (including E/M assignment) coding experience in a multi-specialty medical practice or comparable coding experience required

License or Certification Requirements:

  • AAPC/CPC (Certified Professional Coder) required
  • AAPC/CPMA (Certified Professional Medical Auditor) strongly recommended at hire; required within two years of hire
  • AAPC/CRC (Certified Risk-Adjustment Coder) strongly recommended

 

Responsibilities:

  • Completes timely audits of assigned providers and coders for accurate, complete, and compliant ICD-10-CM and CPT/HCPCS code assignment, ensuring that documentation supports the diagnoses reported, E/M level selected, and CPT/HCPCS codes submitted for services rendered during the episodes of care reviewed
  • Reviews audit findings with assigned providers and coders, providing real-time education on opportunities identified and offering objective supporting documentation (e.g., current coding conventions, regulatory/payor-specific requirements, risk-adjustment guidelines, organization-specific policies) to support findings and use as reference
  • Documents audit results in designated Excel log as soon as review is completed
  • Immediately reports adverse audit trends, potential areas of risk, and compliance concerns to management
  • Assists coding compliance lead in creating and publishing monthly provider newsletter
  • Collaborates with coding compliance team and provider-focused coding manager to develop and maintain current coding guidelines for Riverside Medical Group as a whole and its specialists to ensure compliance and consistency across practices and their assigned coding teams
  • Participates in developing and presenting provider and coder education programs as requested
  • Assists coding compliance lead in maintaining orientation materials for new providers, residents, and fellows that reflect current coding and documentation rules and requirements
  • Assists provider-focused coding manager and coding compliance lead in orienting and educating new team members as requested
  • Serves as coding compliance resource to Riverside Medical Group and Riverside Medical Center as requested
  • Assists in provider-focused coding and charge entry as needed to meet fiscal deadlines and backfill staff vacancies

 

Credentials:
Essential:
* CERTIFIED PROFESSIONAL CODER

 

Education:
Essential:
* HIGH SCHOOL DIPLOMA

 

Riverside Healthcare is revolutionizing care using leading-edge technology to diagnose and treat patients. We are ranked top in the nation for performance in neurosurgery, orthopedics, and heart surgery and have also been named one of the nation's 100 Top Hospitals by Truven Health Analytics seven times. Riverside is nationally recognized for our specialty programs in obstetrics, trauma, oncology, rehabilitation, geriatrics, occupational health, psychiatric services, and treatment of alcohol and chemical dependency, as well as patient safety. We combine innovation and convenience at state-of-the-art facilities located in communities throughout the greater Kankakee area.

Riverside Medical Center proves that truly progressive medicine is being delivered in Chicago's southwest suburbs and East Central Illinois. Join a team that is not only concerned with providing the best care possible but also with offering a work environment of advancement and growth. Riverside is a place that embraces a culture where opinions count and dedications is respected, where superior performance is rewarded with competitive salaries and excellent benefits.

Required Experience Level

Intermediate Level