Job Title: Clinical Documentation and Coding Specialist
Location: USF Health
Dept Number/Name: 0-6012-000 / USF Health Prof Integrity Ofc
College/Division: USFHealth/Prof Integrity
Salary Plan: Administrative
Job Code/Title: 4729 / Billing Integrity Consultant
Hiring Salary/Salary Range: $60,000 – negotiable
Position Number: 00009580
Assist the USF Health Faculty, Fellows/Residents, Students and Staff in understanding and complying with Federal, State and third party payer regulations and guidelines related to documentation, coding and billing for healthcare services provided and/or supervised by USF Physicians.
Conducts billing integrity reviews/audits, including reviewing billing submitted with all supporting clinical documentation to assess the extent to which applicable documentation and coding criteria have been met and to identify clinical documentation improvement opportunities.
Provide education in various formats to USF Health providers and staff regarding clinical documentation improvement, coding, supervision and billing regulations and standards.
Assist with developing and executing the annual billing integrity monitoring work plan, and accurate reporting of results to USF Health providers and management.
Research billing compliance related questions arising from reviews, educational activities, and/or PIO inquiries and prepare complete and accurate responses, often requiring research of regulatory resources.
Monitor federal, state and third party payer publications and websites to identify trends, billing risks, new regulations, and the need for updating USF Health standards.
Assist with developing USF Health billing integrity related standards and guidelines and with educational materials on documentation and coding topics for dissemination to the USF Health providers and staff.
Independently perform special assignments and projects, as assigned by the Director.
This position requires certification in health information management or coding such as RHIA, RHIT, CCS-P, or CPC. Requires experience in physician documentation, coding, billing review/audit.
Experience in researching and applying clinical documentation requirements as defined by federal, state and commercial entities.
Experience in physician billing review/audit or clinical documentation improvement.
Experience using Epic electronic health record and MDAudit in a multi-specialty academic physicians group.
Experience with a computerized billing system for multi-specialty physician billing.
Experience in a physician practice setting, including associated business practices and clinical operations.
Experience as a trainer or instructor for physician billing practices, documentation/coding improvement for teaching physicians and residents.
Experience in professional business writing; writing business policies & procedures; creating forms.
Applicable experience in an academic health center faculty practice plan or multi-specialty physician group.
Training and experience with process management, project management, SMART goals, flow charting of work processes.
Broad based and in-depth knowledge of billing for healthcare professional services provided in ambulatory and inpatient settings, ICD coding, CPT coding, and clinical documentation requirements as defined by federal, state and commercial payers.
Demonstrated skills in abstracting professional fee billing from medical records.
Good understanding of medical terminology and medical records.
Solid knowledge of Medicare and Medicaid regulations and laws, rules, and regulations related to teaching physician billing.
Proficiency with Microsoft Office Suite – Word, Excel, PowerPoint
Strong organizational skills to independently and tactfully coordinate and complete complex projects requiring interactions with individuals throughout the organization.
Ability to compose training materials and policies/procedures/standards from general information provided and/or by research related resources.
Ability to maintain positive working relationships with personnel of all levels.
This position is subject to a criminal background check.