Coding and Compliance Specialist - 40hrswk - Peabody NSPG Corporate
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Job Description
SKILLS
Required
- Strong written and verbal communication skills; strong analytical organizational and time management skills.
- Strong knowledge of Microsoft Office product. Computer skills.
Preferred
- Power Point creation/presentation.
- EPIC
EXPERIENCE
Required
- 3 years healthcare experience/medical terminology medical record review experience ICD9 CPT and HCPCS coding experience/proficiency required in a medical office environment
Preferred
- Revenue Cycle Management. Prior Management or Supervisory experience is a plus
EDUCATION
Required
- Associates Degree or 5 years of experience in an allied health role (RT PTLPN)
Preferred
- Bachelors Degree in allied health role
LICENSURE CERTIFICATIONS or REGISTRATIONS
Required
Required Coding Certification (CCSP or CPC through AHIMA/AAPC) within 6 months of hire
Preferred
CRC Specialty Coding Certification through AAPC
SUMMARY
Under the directions of the Director of Revenue Integrity this position will be responsible for CPT and ICD9 coding and ensuring accuracy and maximum reimbursement. In addition the Coder will perform compliance audits and support CMSHCC risk adjustment projects. This position will interface with NSPG Providers and their staff in order to develop collaborative productive relationships.
RESPONSIBILITIES
- Reviews and analyzes patient records according to current compliance policies and providers documents are compliant
- Review patient records and compare with billing system for potential chronic conditions that are present but have not been captured by ICD9 code in the billing system.
- Responsible for administrative duties related to planning scheduling and conducting coding audits and maintaining records of providers audit results for CPT and ICD9 codes.
- Documents results of all coding audits and suggestions for coding and documentation improvement.
- Presents the findings to director providers and other internal departments.
- Creates positive relationships with all medical group providers and office managers.
- Educate and Train providers on how to utilize available tools to improve their knowledge and coding skills while staying within the guideline.
- Customize special education needs from providers as well as delivering strategic communications to assigned providers with specific guidance.
- Conduct training sessions on current billing and coding information in the medical field.
- Gather analyze and deliver information from quality assurance reviews to assess comprehension of training efforts.
- Review research and respond to coding issues
- Guide coding reviews perform random chart audits and training programs to assure coding quality with assigned physician officess.
- Participates in developing implementing and reviewing programs for coding compliance monitoring
- Criteria for benchmark comparisons Organizations policies and procedures
- Providers clinical documentation improvement
- Reports and applications supporting HCC/Risk Adjustment program
- Analyze denial and bill edit information to identify trends and root cause issues and reducing denial write offs.
- Reviewing bill edit and denial information.
- Works with clinic leadership to develop action plans to address bill edit / denial root cause issues implement process improvements and train staff to mitigate errors
- Maintains up to date knowledge of the current changes of coding practices by continuing education and reading resource material.
- Assist physician offices in training and conversion to ICD10 implementation in 2015
- Work is performed without appreciable direction
- Exercises considerable independence in determining objectives and approaches.
- May direct the work of others and/or act as leader of crossfunctional teams
Required Experience:
Unclear Seniority
Employment Type
Full-Time
