Professional Coding Auditor and Educator - Remote

Professional Coding Auditor and Educator - Remote

Job Profile Summary

​This role focuses on activities related to revenue cycle operations such as billing, collections, and payment processing. In addition, this role focuses on performing the following Health Information Management duties: Responsible for the accuracy, maintenance, security, and confidentiality of patient's health information. An organizational related support or service (administrative or clerical) role or a role that focuses on support of daily business activities (e.g., technical, clinical, non-clinical) operating in a “hands on” environment. The majority of time is spent in the delivery of support services or activities, typically under supervision. An experienced level role that requires basic knowledge of job procedures and tools obtained through work experience and may require vocational or technical education. Works under moderate supervision, problems are typically of a routine nature, but may at times require interpretation or deviation from standard procedures, and communicates information that requires some explanation or interpretation.

Job Overview

This position has frequent and daily interactions with Tufts Medicine Professional Group physician and non-physician providers. Responsibilities include supportive coding instruction related to primary diagnosis and procedural coding and ensuring the accuracy of coding and documentation of appropriate E/M visit level and inclusion of ICD-10-CM diagnosis codes. The coder will focus on chart reviews, the detailed physician chart abstraction, related coding education, evaluation of denials, and ensuring regulatory compliance. The coder will share feedback to providers to capture the full scope of work, collaborate with billing specialists on denials and interact with Epic to ensure a smooth workflow for providers.

Job Description

Minimum Qualifications:

1.Associates degree in medical record technology.

2. Completion of Certified Medical Coding Program or two years of professional coding certification with courses in Medical Terminology, Anatomy & Physiology and/or extensive training in physician coding

3. One of the following Certifications: Certified Professional Coder (CPC), Certified Coding Specialist (CCS), Registered Health Information Administrator (RHIA) or Registered Health Information Technician (RHIT).

4. Four (4) years of coding experience, with at least two (2) years in surgical abstraction (physician or medical group in multi- specialty surgical practices, i.e., OBGYN, HEM/ONC, Cardiothoracic Surgery, Neurosurgery, General Surgery, Orthopedics, etc.).

Duties and Responsibilities: The duties and responsibilities listedbelow are intended to describe the general nature of work and are not intended to be an all-inclusive list. Other duties and responsibilities may be assigned.

1.Supports codes from final surgical/procedural operative reports signed by the provider. Reviews the complex (problematic coding that needs research and reference checking) medical records, ensures documentation is supported. Works with Epic to create a supportive work flow, including creation of templates, smart phrases, billing buttons, etc.

2. Audits provider medical records and charges for compliance with coding and documentation standards to ensure compliance with internal and government regulations.

3. Provides continuing review and education of physician and ACPs to ensure appropriate level of care is reported. Partner with practices to review findings of the periodic chart review.

4. Maintains a thorough understanding of anatomy and physiology, medical terminology, disease processes and surgical techniques through participation in continuing education programs to effectively apply ICD-10-CM and CPT coding guidelines to inpatient and outpatient diagnoses and procedures.

5. Correlates information supporting clinical documentation not limited to Pathology, Radiology and/or other Physician Consultations after review by the Attending Physician, wherever appropriate.

6. Regularly meets with physicians and ACPs to provide continuous education on billable services, medical record documentation, the correct use of CPT and ICD-10 codes, missed billing opportunities and erroneously reported services to minimize errors and loss of revenue.

7. Interacts with and provides trends to management, revenue managers and others about coding related issues.

8. Solves any coding related problems and/or answers questions regarding coding issues from the provider, office staff and billing specialists.

9. Collaborates with billing specialists and appeal and edit coders to expedient resolution of accounts.

10. Works together with billing specialists to develop plans to improve charge capture and billing/coding processes.

11. Stays current with CPT and ICD-10-CM coding guidelines and updates. Communicate changes and/or updates to key stakeholders including physicians, ACPs, practice managers and leadership.

12. Reports any potential compliance issues to the director.

Physical Requirements:

1.Professional office environment with typical office requirements such as computers, phones, photocopiers, filing cabinets, etc.

2.This is largely a sedentary role, which involves sitting most of the time, but may involve movements such as walking, standing, reaching, ascending / descending stairs and operate office equipment.

3.Frequently required to speak, hear, communicate and exchange information.

4.Able to see and read computers displays, read fine print, and/or normal type size print and distinguish letters, numbers and symbols.

5.Occasionally lift and/or move up to 25 pounds.

Skills & Abilities:

1.Extensive knowledge of coding surgical procedures, applicable modifiers in multi-specialty setting.

2.Understands and apply appropriate Center Medicare Services guidelines to coding.

3.Advanced ICD-10-CM & CPT-4 coding conventions.

4.Knowledge of Anatomy & Physiology and Medical Terminology.

5.Extensive OPPS/APC/ACO reimbursement knowledge.

6.Coding software familiarity.

7.Effective written and verbal communication skills.

8.Ability to perform error-free Data entry/CRT.

9.Code and abstract from Surgical Operative Notes while providing the primary communication w/ specialty surgical providers in the health system.