The Clinical Coding Specialist RN will play a clinical role in the coding department. Responsibilities will include responding to questions from the coders, providing physician education as it relates to coding, chart reviews for targeted areas of risk, working in conjunction with multidisciplinary teams to improve the case mix index, identification of issues to be addressed through education or process improvement. Serves as the coding clinical liaison to physicians, healthcare providers and other areas of the organization. Reviews and responds to outside government and third party audits. Is responsible for monitoring for all coding related audit activity in the organization’s tracking mechanism.
Essential Job Functions
• Supports and models behaviors consistent with Billings Clinic’s mission, vision, values, code of business conduct and service expectations. Meets all mandatory organizational and departmental requirements. Maintains competency in all organizational, departmental and outside agency standards as it relates to the environment, employee, patient safety or job performance.
• Partners with other departments to improve reimbursement in targeted areas of coding and coordinates process changes necessary to accomplish clinical practices that result in improved reimbursement and/or reduced costs.
Responsible to gather clinical and financial data for proactive analysis, reviews and internal audits. . Responsible to maintain databases and documentation to support statistics on improved reimbursement and reimbursement recovery.
Reviews, analyzes and interprets coding changes and billing regulations and alerts physicians and management to ensure coding procedures used comply with all regulations and ensure maximum reimbursement for services rendered.
Monitors and performs internal audits to assure compliance with needed changes in coding and documentation are followed. Provides education to staff and physicians.
• Research new technologies and new service lines for compliant coding, documentation requirements and reimbursement information. Report findings to department managers and appropriate leadership. Audit to ensure compliance in process, coding, documentation, and to ensure maximum reimbursement is captured. Meets with equipment and drug vendors to ensure proper reimbursement for new equipment/products.
• Identifies educational issues and/or opportunities for all levels of Billings Clinic leadership and professional staff as it relates to reimbursement and coding practices. Develops and presents information to diverse audience groups regarding analysis, trending and recommendations for actions.
• Develops and maintains education for new and existing physicians and non-physician practitioners related to documentation requirements and coding practices.
• Responds to and reviews clinical coding questions from the coding staff and provides clinical direction. Acts as a liaison between coding staff, physicians, healthcare providers and external customers to resolve questions about documentation and/or coding.
• Monitors all coding related audit activity in the organization’s tracking tool. Clinical review of all coding related external audits determinations. Apply clinical and coding assessment skills to medical record, and extract supportive documentation for appeals. Report any issues to the department managers and compliance team. Provide clinical documentation education to appropriate staff and physicians. Communicate with outside agencies when necessary to clarify issues.
• Performs other duties as assigned or needed to meet the needs of the department/organization
