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Physician Coding Compliance Specialist

Company: Renown Health
Location: Reno
Posted on: November 11, 2019

Job Description:

Position Purpose

Under the direction of the Director of Professional Billing Services and the Manager of Professional Services Coding, the Physician Coding Compliance Specialist is responsible for provide education and documentation monitoring for Providers and Professional Coding Staff. This position is responsible to monitor documentation and coding performance to maintain a 95% accuracy. This position will tend and report documentation accuracy to Compliance and the Director of Professional Billing Services. This position is responsible to keep abreast of continual changes in Coding and Billing guidelines and compliance related to reimbursement within Federal and State Regulations.

Nature and Scope

The Physician Coding Compliance Specialist is responsible for:


  • This incumbent is to have expert knowledge of accurately assigning ICD-10 CM diagnostic and procedure codes.
  • This position is responsible for implementing processes for education to Providers, Revenue Cycle staff and other stakeholders on appropriate documentation criteria and billing to support compliance and reimbursement of Professional Services.
  • Providing orientation and in-service training for all departments relating to appropriate billing, coding, and documentation practices.
  • This incumbent is responsible for monitoring, developing, implementing, and maintaining a data quality management plan and facilitating improvement in overall quality, completeness, accuracy of medical record documentation and coding for professional services.
  • Utilize project management skills, clinical knowledge, and understanding of documentation and coding requirements to improve processes and compliance. Provide in-service training for all providers and coders relating to proper documentation practices, coding, and billing.
  • Provide operational feedback and direction for coding and documentation activities, audits, and education.
  • Provide direction for coding and documentation activities, audits, and education.
  • Assisting Manager in initiating workflow improvements and standardization to increase efficiency and accuracy of documentation and coding.
  • Serving as a liaison between Professional Services Coding and clinical staff to expediently resolve documentation and coding issues.
  • Establish, implement, and maintain a formalized review process for compliance, including a formal audit process.
  • Assisting Manager in developing and making recommendations for accurate set-up of new charge capture build in accordance with billing policies and reimbursement principles, clinical documentation practices, and coding standards.
  • Maintaining a current working knowledge of trends, regulations, policies, and issues concerning third party payers.
  • Continually reviewing and monitors regulatory requirements to ensure charge capture practices are accurate and compliant.
  • Participating as a subject matter expert in cross-functional teams on projects such as Epic implementations, new facilities/acquisitions, and new departments, or service lines.
  • Researching and recommending changes to existing Epic build to automate processes that will lead to enhanced reimbursement and reduction of denied claims.
  • Working collaboratively with members of various departments to drive decisions that meet system, payer and workflow requirements.
  • Developing a review and analysis process in order to ensure that all appropriate and documented diagnoses are captured in order to facilitate maximum reimbursement as part of the Renown Health Accountable Care Organization.


    The foregoing description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills and efforts or work conditions associated with the job. It is intended to be an accurate reflection of the general nature and level of the job.

    Incumbent must have the skill set to:


    • Work both in a team and individual environment, and is confident working with a wide variety of healthcare professionals.
    • High-level thinker with the ability to analyze complicated materials, such as coding and documentation audits, and place in a format all knowledge levels can understand easily.
    • Strong communicator, both written and oral, with an enthusiasm for speaking in front of groups.
    • Ability to gauge knowledge and instruct individuals accordingly, with an emphasis on personalized education.


      KNOWLEDGE, SKILLS & ABILITIES

    • Knowledge and specific details of coding conventions and use of coding nomenclature consistent with CMS Official Guidelines for Coding and Reporting ICD-9-CM/ICD-10-CM coding.
    • Expert knowledge of Evaluation and Management Guidelines and auditing in order to coordinate provider education and identify possible revenue opportunities.
    • Accurate translation of written diagnostic descriptions to appropriately and accurately assign ICD-9-CM and ICD-10-CM diagnostic codes to obtain optimal reimbursement from all payer types, including Medicare/Medicaid, and private insurance payers.
    • Knowledge of clinical content standards.
    • Ability and knowledge of the appeal process to ensure accurate reimbursement.

      This position does not provide patient care.

      Disclaimer

      The foregoing description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills and efforts or work conditions associated with the job. It is intended to be an accurate reflection of the general nature and level of the job.

      Minimum Qualifications

      Requirements - Required and/or Preferred

      Name

      Description

      Education:

      Must have working-level knowledge of the English language, including reading, writing and speaking English. Requires CPC, CCS-P, CCS Coding Certification.

      Experience:

      Requires four years of progressively responsible experience in healthcare and professional coding environment, including ICD-10-CM, CPT and HCPCS Coding and 2 years of auditing experience. CPMA Certification preferred.

      License(s):

      None

      Certification(s):

      Certification in CPC, CCS, RHIA, RHIT or other accredited specialty coding certification. Must attain CPMA, CEMC or other related certification within 12 months of employment.

      Computer / Typing:

      Must be proficient Microsoft Office Suite, including Outlook, PowerPoint, Excel and Word and have the ability to use the computer to complete online learning requirements for job-specific competencies, access online forms and policies, complete online benefits enrollment, etc.

Keywords: Renown Health, Reno , Physician Coding Compliance Specialist, Healthcare , Reno, Nevada

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