Job Title: Physician Services Coding Auditor and Educator
- Under the direction of the Coding Manager, and following a pre-determined or assigned audit schedule, provide an evidence-based audit of select primary and specialty care E&M and procedural charges to ensure correct coding, legal compliance and complete charge capture.
- Using CPT and ICD-10, HCPCS II, provider documentation and other approved resources, evaluate the proper assignment of procedure, modifier and diagnosis codes to professional services in order to validate accuracy and compliance.
- Collate, transfer and analyze all auditing results to capture and illustrate risk issues, revenue leakage and educational opportunities.
- Provide physician feedback, initial and ongoing education and training, and technical support in regards to proper clinical documentation guidelines, service selection, charge capture and timely submission, healthcare data accuracy and coding principles.
- Collaborate with the Physician Services Coding Supervisor, Physician Services Coding Specialists, Physician Billing Managers, WDPC Administration and Information Systems to identify and develop new processes, software development and provider training opportunities based on the audit results.
- Based on feedback from Physician Services Coding Specialists, physician audit results, and accuracy expectations as determined to maintain correct coding standards, coordinate the educational opportunities for the assigned direct-care providers in regards to the medical and legal aspects of professional coding and documentation requirements.
- Assist with developing and implementing recommendations for changes in policies and procedures relevant to correct and compliant coding.
- Serve as a resource for physicians, billing and coding staff and administrative staff relative to technical guidance on professional coding issues.
- Stay current with all coding changes and updates through regular research and verification.
- Perform other projects as assigned by Supervisor and Director of Medical Information.
- Three-Five years E&M coding/auditing experience in any medical specialty. Greater than five years is preferred.
- One year experience in surgical and outpatient procedural coding is required.
- Experience in professional-fee billing is desired.
- High School Education or Equivalent.
- Successful Completion of a post-secondary Billing or Coding Program or Coursework, or the equivalent combination of experience, education and training is required.
- Associates Degree in a health or business related field is strongly recommended. Bachelors degree is a plus.
- Additional nationally-accredited continuing education in a medical auditing, surgical or specialty coding methodology is strongly preferred.
- Medical Terminology coursework required.
- Anatomy & Physiology or Pathophysiology required.
- Ability to assign, sequence and validate all CPT, ICD-9, ICD-10-CM, HCPCS codes with appropriate modifier usage is required.
- Working knowledge of CCI edits and other regulatory guidance is required.
- Ability to develop, implement and deliver and assess coding education plans using a variety of methods to individual providers or provider groups.
- Understanding of Healthcare insurance guidelines as relevant to correct coding initiatives is necessary.
- Advanced level reading, writing and oral communications skills are essential.
- Must have good working knowledge of Microsoft Office and PowerPoint.
- Experience in working with multiple reports, spreadsheets and graphs in an Excel format is required.
- Must be able to function within a pre-determined schedule, and be able to meet deadlines consistently.
- The ability to work in a collaborative manner with coding staff, practice administrators and physicians to determine team needs and prioritize workflow.
- Organizational skills, self-motivation, and the ability to work independently with minimum supervision is essential.
- Experience in using medical billing software and an electronic medical records is required. Next Gen Practice Management/EMR System software experience is highly desired.
- Must have the ability to research and analyze data, draw conclusions and resolve issues, read, interpret and apply policies, procedures laws and regulations.
- Must have the ability to read and interpret medical procedures and terminology.
- CPC, CCS-P or PCS required, additional specialty certifications strongly preferred.
- CEMC or CPMA or other nationally recognized medical auding is a plus. CPMA Certification will be required within one year of hire.
- This position does not supervise staff.
Pam Brooks, MHA, COC, PCS, CPC, AAPC Fellow