• Ensure that coding and documentation for assigned areas meet facility’s compliance and quality standards.
• Serve as a coding resource to staff.
• Perform needs assessment and implement coding education for practitioners, ancillary staff, Business Operations, and CIS staff.
• Research and teach complex coding issues and maintain a knowledge base regarding policies and guidelines from CMS and other payers.
• Evaluate medical record documentation against coding and billing compliance standards and provide detailed reports of findings.
• Develop and implement coding improvement plans.
• Consult with providers and business office staff to advise on coding issues.
• Serve as a Committee Member or Project Manager for coding issues.
• Extensive knowledge of healthcare billing and reimbursement including industry standard billing rules, Medicare, Medicaid, L&I and commercial insurance required.
• Knowledge of adult learning theory and instructional approaches required.
• Knowledge of medical terminology, medical science, disease processes, anatomy, and physiology required.
• Five (5) years Progressively responsible experience in ICD-9-CM, CPT and HCPCS coding in a clinic setting, including advanced chart auditing experience required.
• Progressively responsible roles in clinical coding, business, and training required.
• Experience in application of compliant coding principles, including Medicare compliance issues required.
• Certified in one the following at the time of hire: CPC or CCS-P and ICD-10 CM.
• Bachelor’s Degree highly preferred.
• Intermediate extensive knowledge of Medicare compliance issues and healthcare coding, billing, and reimbursement in a fee-for-service environment highly preferred.
• Knowledge of APCs, DRGs, EpicCare, and Last Word highly preferred.
• Hospital and clinic experience highly preferred.
• 7 years Progressively responsible experience in ICD-9-CM, CPT and HCPCS coding in a multi-specialty practice, hospital professional and hospital facility settings, including chart auditing experience.
• Demonstrated success working with delivery system staff, including creating and delivering formal and informal educational programs.
• Progressive experience in the application of compliant coding information in a complex clinical setting.
• Demonstrated experience in enterprise clinical information systems (EpicCare).
• Project management experience in handling complex and sensitive compliance projects.
• Bachelor’s Degree.
• Eligible and willing to obtain shortly after hire: RHIT, RHIA or CPC-H.