1. Conduct compliance reviews of procedural and diagnosis coding, billing and medical record documentation performed by clinical services providers and coding and billing associates at all Nemours sites, or as requested by the Coding Integrity Director. 
2. Prepare reports as required relative to monitoring and review activities. 

3. Conduct post-review meetings with clinical services providers and coding/billing associates.

4. Conduct education sessions for clinical services providers and coding and billing associates on coding and billing regulations. 

5. Work closely with coding and billing associates at all sites to assure compliance with Nemours on coding, billing, monitoring and review activities.

6. Assist in the development of Nemours policies, and monitoring and review activities as required.

7. Participate in planning sessions with the Coding Integrity Director to develop clinical services provider coding review schedule based on clinical service providers’ historical coding accuracy and organizational needs

9. Monitor and communicate additions and/or revisions to coding and documentation rules, regulations. Assist in development of system-wide coding and billing policies, as requested.

10. Coordinates effectively with Nemours Compliance and Internal Audit Services staff as required.

11. Periodically monitor and report on the coding interfaces associated with the Nemours Electronic Medical Record (Epic). 

Position Qualifications:

1. High School diploma required, Associate Degree preferred

2. Must be a certified professional coder with either the AAPC or AHIMA

3. Minimum five years hands-on experience in physician coding

4. Thorough knowledge of CMS’ coding and documentation guidelines

5. Knowledge of third party physician service billing practices and systems (commercial and governmental)

Licenses, Registrations, Certifications:

• Certified Professional Coder (CPC) or Certified Coding Specialist-Physician (CCS-P) certification is required.
• Attending conferences, webinars, and local chapter meetings to maintain continuing education units in order to stay certified.