Overview
This position reports to the Director of Healthcare Compliance. Responsibilities include conducting billing and coding audits, and communicating results and recommendations to providers, management, and executive administration. This role will provide training and education to providers and ancillary staff. This position will support the implementation of changes to the CPT, HCPCS and ICD-10 codes on an annual basis.
Responsibilities
Essential Functions:
- Conduct prospective and retrospective chart reviews (i.e. baseline, routine periodic, monitoring, and focused) comparing medical record notes to reported CPT/HCPCS and ICD codes with consideration of applicable payer coding requirements.
- Identify coding discrepancies and formulate suggestions for improvement.
- Communicate audit results/findings to providers and/or ancillary staff and share improvement ideas.
- Work with medical staff department to identify and assist providers with coding.
- Report findings and recommendations to compliance and executive leadership.
- Provide continuing education to providers and ancillary staff on CPT/HCPCS and ICD-9/10 coding.
- Support compliance policies with government (Medicare & Medicaid) and private payer regulations.
- Work closely with all departments, including but not limited to, Clinical Services, Nursing, Practice Leadership, Finance, IT, Training, Rev Cycle, and Billing to assist in accuracy of reported services and with chart reviews, as requested.
- Work with the purchasing department to order and distribute annual coding materials for all clinical sites and departments.
- Advise Compliance Officer of government coding and billing guidelines and regulatory updates and work closely with department personnel to provide coding/compliance support.
- Participate in the development and enhancement of EHR templates and programming and advise on coding compliance with payor guidelines.
- Perform other duties as assigned.
Knowledge, Skills and Abilities:
- Proficiency in correct application of CPT, HCPCS procedure and ICD-10-CM diagnosis codes used for coding and billing for medical claims. High
- Knowledge of medical terminology, disease processes and pharmacology.
- Strong attention to detail and accuracy.
- Excellent verbal, written and communication skills.
- Ability to multi-task.
- Excellent organizational skills.
- Proficient in Microsoft Office Suite.
- Critical thinking/problem solving.
- Ability to provide data and recommend process improvement practices.
Qualifications
Education:
- High School Diploma or equivalent (higher degree accepted) with 5 years of experience
- Associates Degree (higher degree accepted)
Licenses/Certifications:
- Certified Professional Coder (CPC®) through AAPC OR Certified Coding Specialist (CCS®) through American Health Information Management Association (AHIMA) required.
Required Work Experience:
- 5 years Experience in a medical office or medical environment.
- 5 years Experience in procedural and diagnostic coding.
- 5 years Extensive knowledge of current trends in the industry based on Medicare and Texas Medicaid as well as national coding updates, such as AMA correct coding, nationally recognized coding references and/or appropriate list serves.
- 5 years Extensive knowledge of Centers for Medicare & Medicaid (CMS) regulations.
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