Job Description

REPORTING RELATIONSHIPS/SUPERVISORY RESPONSIBILITIES This position reports to the Director, Professional Coding, Audit & Education has no direct reports.

POSITION SUMMARY

Conducts audits of physician/provider documentation and coding for office and surgical procedure encounters. Develops and delivers education to physicians, providers, office/department support staff and revenue cycle staff on compliant documentation and coding practices, including regulatory changes or updates. Reviews medical record documentation and claims data to ensure compliance with CMS and payer guidelines and regulations.

ACCOUNTABILITIES

All duties listed below are essential unless noted otherwise Assist in coordinating and developing an educational plan that encompasses accurate documentation, coding, and billing procedures to obtain appropriate reimbursement. Provide regularly scheduled education for providers and staff on appropriate coding and billing in the professional environment, including ICD-10, CPT and HCPCS coding. Design educational documents and tools to improve the level of knowledge of documentation requirements and CPT and ICD-10 coding guidelines for providers and staff. Research and communicate government and private insurance carrier coding/billing policies and guidelines to appropriate providers and staff. Perform audits to determine documentation compliance and coding/billing accuracy; summarize findings and develop plans to improve outcomes. Review code change requests to determine accurate coding and/or advise coding or billing changes to ensure appropriate reimbursement. Conducts reviews of coding denials or other payer requests; performs appropriate follow up including appeals and corrective actions with departments and staff. Assist in reviewing and updating physician documentation templates and forms consistent with coding/billing guidelines and system policies. Assists with training new staff or other special projects. Perform other duties as assigned. This position can be worked remote. Must live in 150 mile or less radius for required in-person meetings. REQUIRED QUALIFICATIONS Education: Associate degree, preferably in a health information management or related field. Skills: Extensive knowledge of ICD-10, CPT and HCPCS coding. Advanced knowledge of anatomy and physiology and medical terminology. In-depth knowledge of reimbursement systems and prospective payment methodologies. Must be detail orientated and have the ability to work independently and accurately resolve problems. Requires excellent verbal and written communication skills. Years of Experience: Minimum of 3 years of physician/professional complex surgical and E&M coding experience in a health care system or medical office setting. Experience performing physician coding audits, including E/M. Certification: One or more current credentials: CPC, CCS-P, CPMA, RHIT or RHIA

PREFERRED QUALIFICATIONS

Education: Bachelor’s Degree in health information management or related field. Skills: High level proficiency and knowledge of spreadsheets, databases, reimbursement and Epic EHR Systems. Years of Experience: 3-5 years of physician/professional complex surgical and E&M coding experience in a health care system or medical office setting. 1-2 years of experience in professional coding auditing and provider education. License: N/A Certification: RHIA/RHIT, CPMA

ADDITIONAL EXPERIENCE

Working knowledge of human anatomy and physiology, disease processes and demonstrated knowledge of medical terminology. Knowledge of CMS and third-party payer profiles and reimbursement requirements. Knowledge of current and developing issues and trends in medical coding procedures and requirements. Must demonstrate the ability to independently, and accurately, resolve problems. Ability to interact and communicate with individuals at all levels of the organization. Must be able to understand directions, professionally communicate and respond to inquiries. Requires a strong commitment to customer service and effective interpersonal skills. Must be able to input and retrieve information from system network and applications. Must have the ability to manage large volumes of work, ability to quickly learn and retain information regarding issues that present themselves. Must have strong organizational, quantitative, and analytical skills as well as the ability to multi-task.

WORKING CONDITIONS

Personal Protective Equipment: N/A Physical Demands: Must be able to work remotely and prolonged periods of sitting. Must be able to understand directions, communicate and respond to inquiries; requires excellent interpersonal skills. Remote Work: If eligible, must follow Corporate Remote Work Policy, CP 3.15 and Corporate Flexible Work Arrangement Policy, CP 3.60. Compensation range: $41,496 - $84,240 We offer a competitive benefits package with coverage effective day one of employment which includes medical, dental, vision, company paid life insurance, paid time off, a 401k retirement plan, an employee assistance program and other voluntary coverage options and employee discounts. The above list of accountabilities is intended to describe the general nature and level of work performed by the incumbent; it should not be considered exhaustive. ProMedica is a mission-based, not-for-profit integrated healthcare organizational headquartered in Toledo, Ohio. For more information, please visit Qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, religion, sex/gender (including pregnancy), sexual orientation, gender identity or gender expression, age, physical or mental disability, military or protected veteran status, citizenship, familial or marital status, genetics, or any other legally protected category. In compliance with the Americans with Disabilities Act Amendment Act (ADAAA), if you have a disability and would like to request an accommodation in order to apply for a job with ProMedica, please contact [email protected] Equal Opportunity Employer/Drug-Free Workplace Requisition ID: 91849 ProMedica Health System

Job Tags

Remote job, Full time, Flexible hours,

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