Compliance Educator I

Essential Functions
Demonstrate a contribution to the department’s operation (Practice Assessments, retrospective &/or concurrent documentation reviews) and goals/targets for the year. Maintain monthly log of activity. Prioritize workload and maintain control over interruptions.

Develops educational materials to conduct classroom and/or Individual training/education to all providers and staff on coding, documentation, and CMS/Federal guidelines.

Researches, analyzes, and responds to inquiries regarding inappropriate coding, denials, and billable services in accordance with all CMS/Federal and state guidelines.

Reviews Hospital and Clinic notes.  Conducts coding and documentation reviews: review documentation and coding for all services (including but not limited to; E & M level of service, Surgical procedures, modifier usage, diagnosis code supporting medical necessity, labs and radiologic examinations).

Review all reimbursement tools for coding/policy additions, revisions and deletions. Items must be communicated in a timely manner to all pertinent providers and staff.

Remain current with CMS/Federal guidelines (i.e., federal register, transmittals and LCD’s). Review all updates published daily and distribute information to providers and staff.

Identifies specific aberrances and atypical billing. Identify potential risks to the organization and ensure compliance to policies.

Supervisory Responsibility

None

Work Environment & Physical Demands
Ability to communicate effectively with providers and staff regarding compliance reviews. Ability to multitask in hectic and fast-paced environment.

Travel
Must be able to travel to various locations within the main clinic, to Regional Clinic locations and to Hospital(s).

Required Education and Experience
High School diploma or equivalent. A minimum of 2-3 years in healthcare reimbursement &/or coding experience. Knowledge in medical terminology and anatomy. Knowledge of insurance reimbursement, principles, and practice. Proficiency with Microsoft Office.  Certification: American Academy of Professional Coders (AAPC) – CPC or equivalent organization, American Health Information Management Association, AHIMA –CCS) for a minimum of 2 years. CRC (Certified Risk Coder) certification obtained within 6 months of date of employment.

Preferred Education and Experience:
Knowledge of GE-IDX, Epic, & Cerner for retrospective or concurrent documentation reviews.