Revenue Cycle Management- Coding & Documentat

ESSENTIAL FUNCTIONS OF THE JOB: (This list may not include all of the duties that may be assigned.)

1. Develops and provides educational and training programs regarding elements of the coding compliance program, such as appropriate documentation and accurate coding, to all appropriate personnel, including coding staff, Clinicians, billing personnel, ancillary departments.
2. Reviews medical records to ensure documentation and coding accuracy, and communicates statistical review results to department management, coders, Clinicians, and other appropriate staff. Makes recommendations to management for corrective action. Provides daily support as needed.
3. Evaluates the adequacy and effectiveness of internal and operational controls designed to ensure that coding processes and practices lead to appropriate execution of regulatory requirements and guidelines related to coding practices including federal and state regulations and guidelines, CMS and OIG compliance standards.
4. Stays current with federal, state, and commercial payer regulatory changes and updates including communicating relevant information to maintain performance and reduce the risk of audit or denials. Demonstrating a broad based knowledge of third party payer billing requirements, medical necessity review guidelines, case mix analyses, core (quality indicators), and OIG initiatives.

1. Other various duties as assigned, including cross training in other functional areas.

TYPICAL WORKING CONDITIONS:

• Non-patient facing, working in a professional office environment
• May rotate working in the office and remote/telework, if remote, this job must be U.S. based
• May require sitting or standing for long periods, including stooping, bending, stretching
• Requires occasional lifting of files and boxes weighing up to 25 lbs
• Requires manual dexterity sufficient to operate a keyboard, type at 35 wpm, operate copier, and other office equipment

PERFORMANCE REQUIREMENTS:

• Experienced leadership and expertise in direct management of business operations.
• Knowledge of and experience in developing workflow plans with subsequent training, implementation and performance analysis as it relates to corporate goals.
• Excellent communicator and team leader influencing peers and employees effectively in order to achieve stated goals.
• Performance driven and accountable to establish team and individual goals, monitor and report to senior management.
• The ability to represent the Company both internally and externally in order to forward organizational goals and initiatives.
• Skilled with interpreting business analytics as well as developing regular reporting for staff, peers and senior management
• Adhere to all organizational information security policies and protect all sensitive information including but not limited to ePHI and PHI in accordance with organizational policy, Federal, State, and local regulations.

Education: Associate degree required. Three (3) years of directly related work experience may substitute for the associate degree. Bachelors of Science preferred.

Licensure/Certification: Maintain at least one relevant coding certification:

• Certified Pediatrics Coder (CPEDC) through the American Academy of Professional Coders (AAPC)
• Certified Professional Coder (CPC) through the AAPC
• Certified Coding Specialist (CCS) through the American Health Information Management Association (AHIMA)
• Certified Coding Specialist-Physician (CCS-P) through the AHIMA
• Certified Medical Coder (CMC) through Practice Management Institute
• Registered Health Information Administrator/Technician (RHIA/RHIT) through the AHIMA
• Additional Certified Professional Medical Auditor (CPMA) or COC certification is preferred

Experience:

• Previous experience training Clinicians is preferred
• Clinical experience is strongly preferred (MA, LPN/RN, Foreign Medical Graduate, etc.). Alternatively, knowledge gained though medical terminology or college level medical courses.
• Minimum 2 year of outpatient/ambulatory coding experience required. Familiarity with CMS billing regulations and requirements, commercial and Medicaid billing guidelines and payer reimbursement models, and relevant state laws/regulations.
• Computer literate in Word, Excel, and PowerPoint

Knowledge, Skills & Abilities:

• Excellent knowledge of CPT-4, ICD-10-CM/PCS and HCPCS coding principles, governmental regulations, protocols, and third party payer requirements pertaining to billing, coding and documentation.
• Knowledge of basic medical terminology/anatomy/pathology.
• Experience working with multiple Electronic Medical Records, with eCW experience strongly preferred.
• Ability to work independently.
• Strong interpersonal and presentation skills paired with advanced written and verbal communication skills.
• Strong analytical and writing skills required for proposal and report development.
• Knowledge of medical coding and documentation education training and development preferred
• Advanced Excel and Outlook skills, strong analytic and problem-solving abilities
• Excellent verbal and written communication skills
• Excellent interpersonal skills with the ability to engage at all levels of the organization
• Ability to efficiently multi-task, plan and prioritize a large volume of detail-oriented work in accordance with changing deadlines, ability to communicate goals clearly and compassionately