POSITION SUMMARY:

Audits charts for appropriate coding documentation practices. Maintains current knowledge of charge reporting of related CPT and ICD-10 systems. Provides regular education programs to providers and other professional staff. Reviews inpatient, surgery center and outpatient records and assigns appropriate CPT and ICD10 diagnosis. Provides feedback and information to providers ensuring adherence with compliance guidelines and expedited reimbursement. Participates in continuous quality improvement activities and educational experiences in support of departmental philosophy and objectives, as well as, Health System initiatives.

EDUCATION/TRAINING:

At least two years of CPT, ICD-10 coding systems and chart auditing experience preferred.

LICENSURE/CERTIFICATION:

Current Certified Coding Specialist (CCS) or Certified Professional Coder (CPC) or equivalent.

EXPERIENCE/SKILLS/ABILITIES:

At least two years of CPT, ICD-9/10 coding systems and chart auditing experience preferred. Experience preferred in educating physicians regarding coding, charting and other relevant processes, in an individual and group setting. Knowledge of medical terminology and anatomy and ancillary tests/procedures. Excellent organizational skills and strong attention to detail required. Strong oral presentation skills. Ability to decipher documentation from various physicians. Must be able to pass a coder assessment test with at least a 80% score. The assessment test is administered by the Coding Education Specialist.

ESSENTIAL FUNCTIONS:

1. In collaboration with Coordinator, educates new and established providers and other professional and clerical staff on appropriate use of procedure and diagnoses coding systems and corresponding documentation requirements. Assists in the development of education tools to assist providers.

1. Audits medical records, interpreting clinical information to determine if documentation is appropriate for serviced billed in response to compliance regulations, payer denials and patient inquires.

1. Reviews documentation and/or charge tickets of assigned specialists to ensure proper procedures and diagnosis coding and minimize payer denials.

1. Sets up codes and fee schedule for new and revise service codes. Evaluates changed needed to charge documents and other educational tools.

1. Acts as resource for all billing providers regarding coding and compliance issues.

1. Assist EMR team with coding and documentation templates for accurate coding and documentation.

1. Processes assigned work files monitoring timeliness of resolutions. Posts predetermined charges per coding procedure.