Performs medical record coding and documentation audits for CHST-employed providers. Conducts coding education based on audit findings. Acts as the coding and documentation resource for CHST providers. Assists in developing action plans in response to identified coding and documentation issues.
- Requires depth within a specialized, critical discipline and/or breadth of substantive professional knowledge that crosses disciplines within the professional field
- Interprets internal/external business challenges and recommends best practices to improve products, processes or services
- May lead functional teams or projects with moderate resource requirements, risk, and /or complexity
- Leads others to solve complex problems; uses sophisticated analytical thought to exercise judgment and identify innovative solutions
- Impacts the achievement of customer, operational, project or service objectives; work is guided by functional policies
- Works independently, with guidance in only the most complex situations
- Communicates difficult concepts and negotiates with others to adopt a different point of view
Job Specific Responsibilities:
- Coding Auditing: Performs professional coding/billing audits and any follow up audits to assure appropriate and compliant professional coding and billing is maintained and assists in developing and implementing appropriate work plan if necessary. Performs audits based on the annual coding risk assessment and assists in developing and implementing appropriate work plan if necessary. Performs supplementary coding/billing audits as requested.
- Coding Education: Performs the initial professional coding and documentation training and orientation for new CHST providers. Provides coding training and coaching based on audit results. Conducts coding and documentation training as requested by management, providers or service line staff. Acts as coding and documentation resource for management, providers and service line staff.
- Policy and Procedure Development and Support: Assists in developing and revising policies and procedures for provider professional coding, documentation and billing to assure compliance with state and federal coding, billing and documentation regulatory requirements.
- Participates on committees or work groups
- Minimum 3-5 years of related experience required
- At least three (3) years professional auditing and coding experience in a provider based setting required
- Moderate to Advanced professional coding experience in more than one specialty (i.e., Orthopedics, Sports Medicine, Cardiology, ENT, etc.) preferred
- Orthopedic coding experience preferred
Specific Knowledge, Skills and Abilities:
- Comprehensive understanding of CPT, HCPCS and ICD-10 codes.
- Basic understanding of revenue process, managed care contracts, reimbursement and professional fee schedules.
- Familiar with federal and state billing guidelines
- Maintain effectiveness when experiencing major changes in work responsibilities or environment; adjust effectively to work within new work structures, processes, requirements, or cultures.
- Use appropriate interpersonal styles to establish effective relationships with customers and internal partners; interact with others in a way that promotes openness and trust and gives them confidence in one's intentions.
- Develop and use collaborative relationships to facilitate the accomplishment of work goals.
- Identify and understand issues, problems, and opportunities; compare data from different sources to draw conclusions; use effective approaches for choosing a course of action or developing appropriate solutions; take action that is consistent with available facts, constraints, and probable consequences.
- Take prompt action to accomplish objectives; take action to achieve goals beyond what is required; be proactive.
- Deal effectively with others in an antagonistic situation; use appropriate interpersonal styles and methods to reduce tension or conflict between two or more people.
- Effectively manage one's time and resources to ensure that work is completed efficiently.
- Accomplish tasks by considering all areas involved, no matter how small; showing concern for all aspects of the job; accurately checking processes and tasks; being watchful over a period of time.
- Set high standards of performance for self and others; assume responsibility and accountability for successfully completing assignments or tasks; self-impose standards of excellence rather than having standards imposed.
- Assimilate and apply new job-related information in a timely manner.
- Clearly convey information and ideas through a variety of media to individuals or groups in a manner that engages the audience and helps them understand and retain the message.
- Two-year Associate's degree or equivalent experience required
- Four-year Bachelor's degree or equivalent experience preferred
Licenses and Certifications:
- Certified Professional Coder (CPC) or Certified Coding Specialist - Professional (CCS-P) required
- Registered Health Information Technician (RHIT) or Registered Health Information Administrator (RHIA) preferred
- Sedentary - Exerting up to 10lbs. occasionally or negligible weights frequently; sitting most of the time.