Job Summary and ResponsibilitiesAs our Coding Provider Educator Professional Fee, you will facilitate and provide detailed analysis, reporting, training, and support for providers and care teams across various medical offices. Your primary objective is to promote accurate clinical documentation and identify risk adjustment opportunities through thorough chart reviews and data analytics.
Every day, you will develop and implement targeted training curriculums, lead educational sessions for providers, and create actionable plans for performance improvement. You will function independently, leveraging a comprehensive understanding of all revenue cycle components to address complex, high-scope projects that support the broader healthcare enterprise, including system billing and reporting.
To be successful in this role, you will need to demonstrate expertise in clinical documentation and revenue cycle management. You should be adept at interpreting complex data to drive improvements, possess strong leadership skills to guide clinical staff, and maintain a focus on the precision and efficiency of the healthcare enterprise's billing and documentation processes.
- Utilize advanced knowledge of disease management, anatomy, physiology, medical terminology, and pharmacology, while maintaining expertise in Optum Encoder, Coding Clinic Guidelines, CPT Assistant, Physician Coding/Billing Guidelines, LMRPs, CMS Program Memorandums, and all applicable Health Plan, AMA, ICD-10, and documentation changes.
- Facilitate initial onboarding and continuous training for all Physicians and APPs. Educate providers-both in-person and remotely-on Risk Adjustment, Hierarchical Condition Categories (HCC), CMS documentation guidelines, and appropriate documentation utilizing MEAT criteria.
- Conduct regular chart audits to identify patterns and opportunities for improved documentation. Systematically trend and track audit findings to update individual provider profiles, identifying specific strengths, areas for improvement, and conditional documentation and coding patterns.
- Build and maintain collaborative, diplomatic relationships with Physicians and APPs. Remain flexible to accommodate provider schedules, ensuring that feedback, guidance, and ongoing support are provided effectively to meet their specific professional needs.
- Demonstrate the ability to understand, retain, and research complex coding and billing rules, regulations, and requirements. Ensure that all assigned Physicians and APPs are fully trained and compliant with CMS guidelines and organizational standards.
- Meet all established productivity and accuracy standards while managing complex projects and assigned deadlines. Utilize excellent problem-solving and organizational skills to work independently and perform under pressure, including the ability to present findings and data as required by management.
Job RequirementsRequired- High School Diploma/G.E.D.
- Five (5) years of recent experience in provider audits, education, and training
- Seven (7) years of experience coding professional fee records
- CPC Source: AAPC or CCS or CCS-P, or RHIT, or RHIA Source: AHIMA Certified Professional Coder (CPC Certification) CCS (Certified Coding Specialist) CCS-P (Certified Coding Specialists - Physician based) RHIT (Registered Health Information Technician) RHIA (Registered Health Information Administrator)
- Knowledge of professional fee coding rules and guidelines
- Understand rules and regulations governing Medicare billing
- Advanced Knowledge of NCCI, ICD-10-CM, CPT, HCPCS, and modifiers
- Advanced knowledge of medical terminology and anatomy and physiology
- Strong organizational, planning, scheduling and project management abilities
- Excellent analytical ability to develop and analyze data to recommend solutions and solve complex
problems - Experience with Epic and health care applications
- Demonstrate excellent interpersonal, organizational, presentation, time-management, multi-tasking, and communication skills with strong attention to detail
Preferred- Associate's Degree or equivalent work experience in lieu of degree
