Position Summary
Performs, develops, and implements coding related efficiency processes to monitor professional coding to ensure optimal efficiency and follow the controlling compliance guidelines with governmental and private payers. The Physician Coding Education Specialist is responsible for analyzing physician coding trends and providing educations that will contribute to effective productivities.
- This opportunity is a hybrid role based out of Leesburg FL, requiring occasional onsite presence and residency in Lessburg or the surrounding area.
Responsibilities
Essential Functions
- Responsible for internal auditing and analyzing professional coding for all service lines.
o Will monitor the audit results closely to identify any potential coding inaccuracy
o Gives the Department the needed support in identifying coding errors
o Gives the practice the security that we are capturing the service accordingly
o Gives providers additional education when needed and requested.
▪ Ensure that medical documentation is following Governmental payers, Managed Care and private insurances guidelines
- Review medical records to ensure accuracy of code assignment.
- Guide and educate coding team members by addressing errors, performance issues, and trends identified through reporting.
- Ability to identify and communicate physician documentation and coding opportunities for improvement
- Takes an active role in developing and presenting educational programs to physicians, physician extenders, and physician offices.
- Effectively communicates best practice physician coding related feedback with physicians, non-physician providers, physician office staff, administration, practice managers, and team members of the Physician and Professional Services Central Business Office.
- Takes the initiative to identify and solve complex trending coding issues affecting the physician revenue cycle and provide the necessary feedback to correct claims on a go-forward basis as well as recovered underpaid amounts.
- Collaborates with Physician and Professional Services Central Business Office to ensure appropriate and complete follow up of patient accounts to ensure coding accuracy for payor guideline reimbursement.
- Addresses all Orlando Health departments professionally and positively, in all settings, by always maintaining a high level of professional demeanor and dress.
- Provides statistical reports to deliver accurate documentation of ongoing internal coding efficiency process.
- Conducts focused physician reviews as needed and provides data to manager.
- Maintains 90% physician coding accuracy rate.
- Attends payor, departmental and interdepartmental meetings as required.
- Prepares/distributes information summarizing opportunities with physician coding monthly.
- Researches, identifies, develops, and assists in implementation of a plan of action to resolve coding disputes with payors.
- Utilizes resource material available in department, CMS, AMA, and AHA to support coding practices.
- Serves as a preceptor to new coders
Qualifications
Skills Knowledge
- Excellent knowledge of CPT-4, ICD-10-CM/PCS and HCPCS coding principles, governmental regulations, protocols, and third party payer requirements pertaining to billing, coding and documentation
- Knowledge of medical terminology
- Experience working with Electronic Medical Records
- Ability to work independently
- Strong interpersonal and presentation skills paired with advanced written and verbal communication skills
- Strong analytical and writing skills required for proposal and report development
Education/Training
- Associate degree required. Three (3) years of directly related work experience may substitute for the associate degree.
- Possesses exceptional knowledge in Microsoft Office Word, Outlook, and PowerPoint as well as moderate to expert
experience with Microsoft Excel.
- Thorough knowledge of official coding guidelines as per AMA, AHA, and CMS as evidenced by results of coding skills test of
90% or better.
Licensure/Certification
Must maintain one (1) of the following national certifications:
- Certified Professional Coder (CPC) through the American Academy of Professional Coders
- Certified Coding Specialist (CCS) through the American Health Information Management Association (AHIMA)
- Certified Coding Specialist-Physician (CCS-P) through the American Health Information Management Association (AHIMA)
- Certified Medical Coder (CMC) through Practice Management Institute
- Additional CPMA or COC certification is preferred
Experience
- 5-6 years of professional based coding experience is required.
- Professional based coding experience must include all types – Clinic, Behavior Health, hospital rounding, SDS, Teaching & Physician extender provider coding, All specialties
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