Description:
GENERAL SUMMARY
The Auditing/Physician Education Specialist provides coding and compliance audits and training to coders, physicians, clinical personnel, and billing staff. Responsible for reviewing medical documentation and ensuring that the documentation and coding accurately reflects the services provided. Effectively communicates with physicians and clinical staff on coding issues and maintains audit logs to track and monitor progress. Facilitates and promotes standardization of coding practices, monitors and communicates regulatory coding and billing changes for timely and accurate implementation. Participates in short- and long-term strategic planning with regard to compliant coding and regulatory billing practices.
ESSENTIAL JOB FUNCTION/COMPETENCIES
Responsibilities include but are not limited to:
-
Identifies target audit opportunities based on industry performance, regulatory focus areas, and risk areas within the organization.
-
Performs monthly detailed documentation and coding audits, focusing on at-risk areas and prior deficiencies, to identify documentation and coding errors, inconsistencies, and omissions.
-
Identifies opportunities for improved documentation and coding and documents the opportunities for ongoing education.
-
Develops audit detail summary spreadsheets and reports to address any coding, documentation, financial and audit findings to leadership, physicians, and appropriate individuals.
-
Reviews chart documentation for accuracy and completeness, identifies inconsistencies in chart documentation and works with appropriate staff and Supervisor, Coding to resolve issues.
-
Edits previously submitted charges as needed due to identified billing rejections and/or insurance requirement changes.
-
Evaluates risk factors in coding and related processes, and ensures guidelines are compliant with federal, state, and other applicable regulations.
-
Collaborates with Coding and Revenue Integrity leadership to design and implement a Provider Documentation Education program to provide focused education to clinical and coding resources.
-
Assists in identifying and implementing process improvements to decrease coding-related denials.
-
Drives continuous improvement by developing, prioritizing, and monitoring improvement activities and key performance metrics.
-
Answers coding and billing questions onboarding and training new staff, performing coding audits, and developing and deploying of coding education.
-
Maintains knowledge of coding regulations and guidelines, including ICD-10 and CPT
-
Performs other position related duties as assigned.
Requirements:
KNOWLEDGE | SKILLS | ABILITIES
-
Demonstrates understanding of business and how actions contribute to company performance.
-
Demonstrates excellent customer service skills.
-
Knowledge of medical terminology, Current Procedural Terminology (CPT), International Classification of Disease (ICD) coding, and the entire revenue cycle process
-
Knowledge of EHR (Electronic Health Record) software systems and Microsoft Office products
-
Professional verbal and written communication skills
-
Ability to develop reports and create presentations.
-
Ability to work collaboratively across disciplines and business lines.
-
Must be comfortable educating staff members.
-
Ability to handle multiple tasks with excellent problem-solving skills.
-
Strong analytical skills with ability to make conclusions and recommendations.
-
Well organized with the ability to maintain accuracy and confidentiality.
-
Complies with HIPAA regulations for patient confidentiality.
-
Complies with all health and safety policies of the organization.
EDUCATION REQUIREMENTS
-
High School diploma or equivalent required.
EXPERIENCE REQUIREMENTS
-
Minimum of five years' coding experience within a physician practice
-
Two years' experience in auditing and/or coding education preferred
-
Experience in Urology physician practice environment preferred
PI242307924