EDUCATION QUALIFICATIONS

• High School Diploma / GED - Required
• Bachelor’s Degree - Preferred

EXPERIENCE QUALIFICATIONS

• At least five (5) years related experience - Required
• Previous experience with teaching Clinicians guidelines that are compliant with the BH (behavioral Health) regulations set by national standards -Preferred
• Billing experience that involved mental health billing and/or nursing - Preferred

SKILLS AND ABILITIES

• Knowledge of Microsoft Office Suite including Word, PowerPoint, Excel; internet research skills.
• Excellent communication, interpersonal skills and presentation required.
• Must be able to communicate with clinical staff, administrators and office staff.
• Excellent organizational skills.
• Analytical abilities.
• Excellent written and oral presentation skills.
• Eagerness to learn new areas and work with little supervision.
• Good judgment.
• Ability to work with confidential materials and to manage multiple tasks.
• Ability to travel to various CHOP locations sites throughout PA and NJ, where BH Providers are serving patients.

• Systematically monitor, review and analyze patient medical records to determine all appropriate diagnosis and procedures performed. Provide feedback and education to providers.
• Shadow providers at each location within the department and provide on-site education with regards to proper documentation and coding.
• Conduct chart audits for the Department to ensure providers are in compliance with coding and regulatory guidelines.
• Conduct on-site training at each location and provide feedback to providers, managers and director.
• Maintaining thorough knowledge of coding and documentation requirements outlined by CPT, ICD-10-CM and CHOP Compliance for all physician services performed.
• Develop and provide coding and documentation seminars for the providers in the Department and/or present at Departmental meetings.
• Inform providers/directors each year of coding changes for the following year.
• Work with Epic support to ensure that new codes are entered into the system in a timely manner.
• Work with Clinical Providers, Managers and Administrative Director to have a working knowledge of BH Commercial and Medicaid contracts and ensure compliance with quality programs.
• Assist in cost/revenue analysis of any new procedures that providers may want to do.
• Review denials report from the Physician Billing group for trends: e.g., Summarize trends from denials report for each service area and provide feedback and recommendations for reducing denials.
• Meet with Clinical Managers, DCAPBS Administrative Managers and Director and Physician billing department monthly.
• Participate in committees as required.
• Develop CPT “Tip Sheets”, disseminate to Clinicians, post on @CHOP and website for all to access, follow up as necessary.
• Meet with members of CHOP’s Coding and Compliance Department to ensure department policies are line with the hospital.
• Provide coding training to new Clinicians hired within the department 30-60 days after their hire date.