Coding Educator

Position Purpose

This position is responsible and accountable for initial and ongoing education of providers and/or coding staff on key revenue cycle topics, including but not limited to coding, documentation, billing policies, and regulatory compliance in regard to facility (HB) and professional (PB) coding. As such, this position takes a significant role in developing the training and curricula necessary to ensure physicians and/or staff reach and maintain a desired level of coding and documentation proficiency across all care settings.

This position is also responsible for ensuring the accuracy of information in these processes is maintained through the conducting and analysis of periodic audits-and, if accuracy is not at the expected level, this individual is responsible for the reeducation and training of physicians and/or staff to ensure these departments are meeting their targets. Additionally, this position is responsible for serving as a figurehead of knowledge as it relates to all coding systems in use (ICD-10-CM & PCS, CPT HCPCS);

CMS, federal, and state coding regulations; and third-party reimbursement requirements.

Incumbent is responsible for conducting and coordinating audits of provider's professional documentation to ensure that correct services are being billed and provide education and consistent feedback to the provider's using identified communication tools. The major challenge of this position is coordinating and managing the provider's auditing and education schedules to ensure compliance of assigned codes, charges, and quality documentation.

Incumbent is responsible for reviewing coded encounters and related documentation to ensure documentation supports the level billed by providers. This position ensures that physician services are coded accurately based on Coding and Reporting Guidelines. Identifying educational/learning needs, planning, evaluating, and implementing educational programs to enhance documentation and coding practices across the organization. Serve as a liaison between the providers, clinical staff, and coders.

Demonstrates attention to detail to minimize coding errors, legitimately optimize reimbursement and ensure accurate billing. The incumbent is responsible for reviews and training across inpatient and outpatient facility accounts, inpatient, outpatient and professional (profee) accounts and overall documentation from providers on all accounts.

Specific Job

Responsibilities include:

• Investigate, evaluate, and identify opportunities for improvement and provide guidance and counsel to providers with face-to-face and/or virtual meetings.
• Identify and review areas requiring attention, performing special reviews/investigations as requested, share this information with leadership and provide one-on-one education with the provider in a timely manner.
• Collect and analyze data, submit reports as assigned and monitor monthly reviews to ensure that they are completed timely.
• Report/record all documentation and coding issues that require follow-up reviews to coding manager.
• Be aware of what is happening in clinic/department and the organization by attending clinic/department meetings, reading e-mails/in-basket messages and regularly checking information on the organization's intranet site.
• Balance team and individual responsibilities; be open and objective to other's views; give and welcome feedback; contribute to positive team goals; and put the success of the team above own interests.
• Perform other duties at the request of various departmental leadership groups to facilitate the smooth and effective operations of the organization.
• Research coding inquires and be a resource for providers, clinical, billing and coding staff.
• Investigate, evaluate, and identify opportunities for improvement and provide guidance and counsel to providers, clinical staff, coding staff, and/or billing staff by setting up small group meetings or training sessions.
• Develop, update, and implement coding department/provider newsletters, education, reference documents.
• Proactively identify areas of opportunity to improve coding quality based on audit feedback, coder questions, physician escalations, denial meetings, and other platforms and plans coder education accordingly.
• Demonstrate the attention to detail to minimize coding errors, legitimately optimize reimbursement and ensure accurate billing.
• Serves as a liaison point of contact for clinical coding inquiries and communication for professional billing…