Professional Coding Compliance Specialist (On-Site

Overview

The Professional Coding Compliance Specialist provides revenue cycle support to Riverside Medical Group and its coding team by regularly auditing provider documentation and corresponding coding to ensure correct, complete and compliant practices that fully support diagnoses reported and charges submitted for services rendered, meet regulatory and payor-specific requirements, and accurately describe the patient encounter; providing feedback and education to providers and coders based on audit results, regulatory changes, and industry trends;

assisting with orientation of new providers, residents/fellows, and new members of the coding team.

• Completes timely audits of assigned providers and coders for accurate, complete, and compliant ICD-10-CM and CPT/HCPCS code assignment, ensuring that documentation supports the diagnoses reported, E/M level selected, and CPT/HCPCS codes submitted for services rendered during the episodes of care reviewed
• Reviews audit findings with assigned providers and coders, providing real-time education on opportunities identified and offering objective supporting documentation (e.g., current coding conventions, regulatory/payor-specific requirements, risk-adjustment guidelines, organization-specific policies) to support findings and use as reference
• Documents audit results in designated Excel log as soon as review is completed
• Immediately reports adverse audit trends, potential areas of risk, and compliance concerns to management
• Assists coding compliance lead in creating and publishing monthly provider newsletter
• Collaborates with coding compliance team and provider-focused coding manager to develop and maintain current coding guidelines for Riverside Medical Group as a whole and its specialists to ensure compliance and consistency across practices and their assigned coding teams
• Participates in developing and presenting provider and coder education programs as requested
• Assists coding compliance lead in maintaining orientation materials for new providers, residents, and fellows that reflect current coding and documentation rules and requirements
• Assists provider-focused coding manager and coding compliance lead in orienting and educating new team members as requested
• Serves as coding compliance resource to Riverside Medical Group and Riverside Medical Center as requested
• Assists in provider-focused coding and charge entry as needed to meet fiscal deadlines and backfill staff vacancies

• Minimum three years current ICD-10-CM and CPT/HCPCS (including E/M assignment) coding experience in a multi-specialty medical practice or comparable coding experience required

• High school graduate or equivalent required.
• AAPC/CPC (Certified Professional Coder) required
• AAPC/CPMA (Certified Professional Medical Auditor) strongly recommended at hire; required within two years of hire
• AAPC/CRC (Certified Risk-Adjustment Coder) strongly recommended

• Associate degree in health-related field preferred
• Formal education in ICD-10-CM and CPT/HCPCS coding principles and assignment maintained by relevant continuing education

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 perform other related duties.

Riverside Healthcare offers a comprehensive suite of Total Rewards: benefits and nationally rated employee well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more so your journey at and away from work is remarkable. Our Total Rewards package includes:

• Base compensation within the positions pay range based on factors such as qualifications, skills, relevant experience, and/or trainin
• Premium pay such as shift differential, on-call
• Opportunity for annual increases based on performance

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

• Paid Leave Hours accrued as you work

Exposure to:

• Chemicals: NA
• Video Display Terminals:
  Average
• Blood and Body Fluids:
  None
• TB or Airborne Pathogens:
  None

• Speech:
  Needed for presentations/training, telephone communication, facilitate meetings.
• Vision:
  Needed to read computer screens and printouts, memos, communications, documentation, and literature.
• Smell:
  Electrical/fire safety.
• Hearing:
  Needed for telephone communications,…