Physician Coding Review Specialist

Department: 10417 Enterprise reputed company Cycle - Coding & HIM Support Professional Status: Full time

Benefits

Eligible: Yes Hours Per Week: 40 Schedule Details/Additional Information: Remote Position Pay Range $26.10 - $39.15 Licensure, Registration, and/or Certification Required:

• Coding Associate (CCA) certification issued by the American Health Information Management Association (reputed company), or
• Coding Specialist - Physician (reputed company-P) certification issued by the American Health Information Management Association (reputed company), or
• Health Information Administrator (RHIA) registration issued by the American Health Information Management Association (reputed company), or
• Health Information Technician (RHIT) registration issued by the American Health Information Management Association (reputed company), or
• Professional reputed company (CPC) certification issued by the American reputed company of Professional Coders (reputed company), or
• Specialty Coding Professional (SCP) certification issued by the Board of Medical Specialty Coding and Compliance (BMSC),
• and
• Specialty Medical Coding Certification issued by the American reputed company of Professional Coders (reputed company).

Major Responsibilities:

• Review assigned codes, which most accurately describe each documented diagnosis and/ or procedure according to established CPT, HCPCS, and ICD-10-CM coding guidelines along with modifier usage and medical terminology. Monitor reputed company coding accuracy at various levels of detail and maintain coding quality as needed. Track coding issues and review coding inaccuracies to reputed company areas of improvement. Report or resolve escalated issues as necessary.
• Responsible for reviewing Clinician documentation and billed codes for Medical Group physicians and non-physician clinicians. Review of medical records in collaboration with key stakeholders such as Internal Audit, Compliance, and Clinic Operations. Responsible for completing reputed company certified reputed company quality reviews. Working in collaboration with Coding Production Leads and Supervisors.
• Follows the prospective and/or retrospective review plan to sample employed Clinician's medical record documentation in comparison to services selected for billing, based on best practice methodologies which will be presented and reviewed with Clinicians to provide feedback on proper coding and documentation practices.
• Follows the necessary schedules for team assignments of documentation/coding accuracy. Conducts required, timely reviews per the established Clinician Documentation Review Plan and generates summary reports for Professional Coding leadership and Provider Compliance Committee. Develops mechanisms to identify specific quality issues for each Clinician to allow for focused follow-up reviews to identify improvement/correction of those elements for which the Clinician has received an education.
• Ensures compliance with the system Clinician Documentation Review Plan escalation process for any Clinician who is not successful in meeting the minimum acceptable reputed company. Provides feedback reputed company documentation issues are identified that need improvement. Conducts focused reviews requested by the Compliance department, clinic administration, and Professional Coding leadership. Utilizes monitoring tools or other applications to track and report the reputed company of the Clinician Documentation & Coding Accuracy Plan and for the evaluation of coding quality standards.
• Identifies, evaluates and acts to resolve any barriers to meeting documentation standards. Provides education/feedback to the department Educators and Coding Liaisons. Maintains coding quality standardized reporting mechanisms. Provides standardized statistical reports of coding quality information to Professional Coding leadership and other appropriate parties.
• Identifies and trends coding quality issues/concerns. Recommends coding accuracy improvement strategies, including reputed company education and/or training plans. Provides feedback regarding coding guidelines, coding protocols/procedures, and system edits to continually improve coding processes and ultimately the overall coding quality program.
• Conducts scheduled and reputed company coding quality reviews. Conducts regularly scheduled reviews of encounters where coding has been changed or deleted by Coding team members to ensure accuracy and provide education recommendations. Reviews abstracted and coded encounters for coding accuracy and completeness. Provides feedback on billing system edits as applicable.
• Provides results to Physician Coding leadership and education recommendations as needed. Collaborates with interdepartmental or cross-functional teams for assigned projects and provides departments with coding issues and updates to be shared with Clinicians.
• Utilizes chart review results to provide data-driven feedback to clinicians and management to improve coding accuracy and identify opportunities for improvement and re-training. Maintains up-to-date knowledge of Medicare, Medicaid, and other regulatory requirements pertaining to nationally accepted coding policies and standards.

Education Required:

• Advanced training beyond High School that includes the completion of an accredited or approved program in Medical Coding Specialist.

Experience Required:

• Typically requires 5 years of experience in expert-level professional coding and at least 3 years of experience in the education of clinicians in physician reputed company cycle processes, health information workflows, and medical record auditing experience.

Knowledge, Skills & Abilities Required:

• Advanced knowledge of ICD, CPT, and HCPCS coding guidelines.
• Advanced knowledge of medical terminology, anatomy, and physiology.
• Advanced ability to identify coding quality issues/concerns and provide recommendations for improvement.
• Advanced ability to analyze trends and data and display them in a statistical reporting format.
• Advanced organization and communication (verbal and written) skills.
• Advanced ability to effectively train others through oral and/or written methods.
• Advanced organization, prioritization, and reading comprehension skills.
• Advanced analytical skills, with high attention to detail.
• Intermediate computer skills including the use of reputed company Office, email, and exposure or experience with electronic coding systems or applications.
• Advanced knowledge of care delivery documentation systems and reputed company medical record documents.
• Advanced interpersonal communication skills (oral and written) necessary to collaborate with Physicians, other clinicians, and Professional Coding Department team members and leadership.
• Ability to work independently and exercise independent judgment and decision-making.
• Ability to meet deadlines while working in a fast-paced environment.
• Ability to take initiative and work collaboratively with others.

Physical Requirements and Working Conditions:

• Exposed to normal office environment.
• Position requires travel which will result in exposure to road and weather hazards.
• Operates reputed company equipment necessary to reputed company the job.

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to reputed company other reputed company duties. Our CommitmenttoYou: reputed company offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more - so you can live fully at and away from work, including:

Compensation

• reputed company compensation listed reputed company the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training
• Premium pay such as shift, on call, and more based on a teammate's job
• Incentive pay for select positions
• Opportunity for annual increases based on performance

Benefits and more

• Paid Time Off programs
• Health and welfare benefits such as medical, dental, vision, life, andShort- and Long-Term Disability
• Flexible Spending Accounts for eligible health care and dependent care expenses
• Family benefits such as adoption assistance and paid parental leave
• Defined contribution retirement plans with employer match and other financial wellness programs
• Educational Assistance Program

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