"Medical Coder Compliance Spec"

Perform coding quality audits on outpatient records to assure appropriateness, accuracy, and compliance for CPT/HCPCs, ICD-10-CM code assignments, and modifier assignment in accordance with Center of Medicare and Medicaid Service (CMS) Guidelines, AMA and AHA Official ICD-10-CM Coding Guidelines. Provide ongoing feedback to managers and coders. Develop and implement educational programs regarding elements of the coding compliance program and act as a subject matter expert for the outpatient coding department.

OPERATIONS

• Perform pre and/or post bill secondary chart review to validate modifier selection, E&M, procedural, and diagnosis coding in accordance with established coding guidelines
• Provide coding training to new hires
• Continuously provide feedback to coding staff to improve code selections that accurately describe the procedures and services performed by physicians in accordance to NCCI, AMA/CPT & ICD 10- guidelines
• Review and dissect coding clinics, yearly AMA guidelines, ICD-10-CM and NCCI to prepare education sessions to outpatient coders.
• Develop and coordinate educational and training programs regarding elements of the Coding Compliance Program, such as appropriate documentation, accurate coding, and coding trends found during chart reviews.
• Respond to complex internal and external customer inquiries in relation to Mid-Service processes, documentation, and coding compliance standards.
• Participate in process improvement initiatives by use of technology
• Demonstrate initiative by the continuous expansion of knowledge and skills
• Participate in department/unit activities including, but not limited to, staff meetings and in-services
• Perform other duties as assigned to maintain the efficiency of the department
• Protect the confidentiality of primary and secondary health records and the information therein as mandated by law, professional standards, and Health System policies
• Demonstrates excellent customer service skills in working with Revenue Cycle staff, clinicians, and other UHMS staff. Model, support and reinforce a culture of service excellence

SKILLSET

• Extensive CPT/ ICD-10-CM coding knowledge with a strong understanding of the AMA, AHA and NCCI Official Coding Guidelines and how to apply them.
• Ability to leverage technology for process improvement.
• Analyze guidelines to provide in-depth education to staff.
• Write appropriate queries to the clinical care team in accordance with the AHIMA Query Policy.
• Attention to detail with thoroughness and accuracy when accomplishing a task.
• Participate as an active member of Lean Thinking in daily work initiatives
• Excellent verbal and written communication skills, analytical thinking, and problem-solving skills with attention to detail are required.
• Proficiency in organizational skills and planning with an ability to juggle multiple priorities in a fast-changing environment
• Experience in developing and providing education to coders and physicians
• Ability to work independently, be self-motivated, and the ability to adapt to the changing healthcare environment.

Associate's degree in healthcare related field or an equivalent combination of education and/or experience

Certified Professional Coder (CPC), or Certified Outpatient Coder (COC), or Registered Health Information Technician (RHIT), or Registered Health Information Administrator (RHIA), or Certified Coding Specialist (CCS/CCS-P) credential.

Three years' experience coding or auditing CPT, ICD-10-CM, and modifier assignment.

Extensive knowledge of federal and state regulations and policies pertaining to documentation and coding.