POSITION SUMMARY

Responsible for performing quality audits regarding coding functions, identifies individuals and develops educational action plans in collaboration with Coding Supervisor in order to assure accuracy for inpatient and outpatient professional coding. Educate physicians and clinical staff on coding guidelines related to professional billing. Perform education, coding and billing review for all new Mount Nittany Physician Group providers. Facilitates and coordinates the monitoring of internal and external coding audits to include third party payers or regulated review agencies. Assists with coding in times of short-staffing, high volumes, vacancy, etc. as needed.

EDUCATION:

• Graduate of an approved Health Information Management Technology program or relevant Technical Certification required.
• Will also consider graduates of Medical Office Specialist program with current experience with ICD-10-CM, CPT, and HCPCS coding rules and methodologies.

EXPERIENCE:

• Minimum of three full years of coding experience required; inpatient and outpatient professional coding experience.

KNOWLEDGE, SKILLS, ABILITIES:

• Excellent communication skills (both verbal and written).
• Ability and ease with presenting educational information in a large group setting.
• Critical thinking skills and the ability to research topics in order to better understand and explain complex medical coding/billing issues is required.
• Self motivated individual with personal integrity to organize work and work independently.
• Strong decision making skills.
• Ability to use computer software (e.g. HIS, Encoder, WORD, EXCEL and PowerPoint).
• Remains calm in changing work situations and is adaptive to changes in routine and schedule.
• Ability to work with Coding Supervisor, Coding Staff, Physicians, Patient Accounts and other departments as needed.

ESSENTIAL FUNCTIONS

• Trains new coders or contract coders to include daily monitoring, feedback and education with oversight from coding supervisor.
• Researches and educates coders on ICD-10-CM and CPT/HCPCS coding changes as well as complex coding issues.
• This would also include yearly ICD-10-CM and CPT/HCPCS updates as well as CMS final rule updates.
• Remains current with AAPC, Coding Clinics, CPT Assistant, CMS guidelines and other required reporting.
• Trains new Physicians/Advanced Practice Provider including contracted credentialed physicians.
• Perform new provider education, coding and billing review in collaboration with coding team member.
• Researches and educates physicians/Advanced Practice Providers on ICD-10-CM and CPT/HCPCS coding changes as well as complex coding issues.
• This would also include yearly ICD-10-CM and CPT/HCPCS updates as well as CMS final rule updates.
• Remains current with AAPC, Coding Clinics, CPT Assistant, CMS guidelines and other required reporting.
• Collaborates with Supervisor HIM Coding MNPG to coordinate presentations of final audit findings to department staff, providers, and appropriate individuals. Works with auditees on corrective action plans and educates management, providers, utilization review/case management staff and/or hospital personnel on documentation, billing, and coding requirements.
• Maintains all records and data logs of the yearly audits performed in a comprehensive summary report and the supporting documents of the audit finding results and conclusion in an approve format.
• Provides audit findings and reports to identify patterns, trends, or variation in coding documentation practices.
• Assist in the development of provider specific training, as well as corrective action plans based on the audit results
• Assists Supervisor HIM Coding MNPG by reviewing records to include coding related correspondence from CMS, other regulatory agencies, insurance providers and internal requests.
• Assist clinical coordinators, managers, corporate compliance or others with any requests, patient complaints or second reviews.
• Presents recommendations to management as well as the provider and/or staff on coding and documentation issues.
• Facilitates and promotes standardization of coding practices and workflow facility-wide.
• Monitors and communicates regulatory coding and billing changes for timely and accurate implementation.
• Assists Corporate Compliance with developing and maintaining compliance plans, Coding and Compliance Policies and Procedures, as well as developing individualized educational plans to improve coder productivity and accuracy.
• Works in conjunction with the Patient Accounts and Finance departments to improve workflows and expedite accurate and compliant billing of patient accounts.
• Assists with coding in times of short-staffing, high volumes, vacancy, etc. as needed.
• Collaborates with Coding Supervisor and Information Services to test and update HIS and Encoding Software.
• Performs internal concurrent, prospective, and retrospective audits to assure that billed services are supported by documentation in the medical record and that all coding, billing, and documentation is compliant with appropriate guidelines and federal and state regulations. Develops audit detail summary spreadsheets and reports to address any coding, documentation, or financial discrepancies.

NON-ESSENTIAL FUNCTIONS

Performs related and miscellaneous duties as assigned.