Under the direction of the AVP of Revenue Cycle Operations you will perform record review of professional billing activity to ensure documentation is appropriate to support expected reimbursement as well as ensuring risk adjustment coding indicators are accurately documented. The ideal candidate possesses extensive knowledge of CPT, HCPCS, modifiers and coding guidelines, notably for surgical service lines and demonstrates the ability to prepare and analyze quality and financial reports. As well as possessing a thorough understanding of legal and compliance issues as they pertain to clinical documentation. Responsibilities for this role include:
Clinical Documentation Quality:
- Development of Professional Billing training material surrounding annual CPT/ICD10 code updates.
- Assists in the research, review and development of new service offerings to determine documentation and reimbursement requirements.
- Works with Revenue Cycle and IS stakeholders to identify top denials attributed to coding issues. Generates communications to physicians, service line leaders, and physician network leadership to address the underlying issues surrounding the denials. Develops training materials as needed to minimize future denials. Assists MLHC CBO with appeals.
- Works in collaboration with MLHC Clinical Quality teams including Medical Directors to provide feedback and education to providers on risk adjustment (e.g. HCC) coding patterns and opportunities.
- Collaborates with MLH Compliance and HIM Departments to ensure MLH's provider documentation expectations are reinforced.
Education
- Develops and administers training presentations to clinical providers, Quality Directors, and coders.
- Develops appropriate education and focused re-training based upon the data trend analysis.
- Conducts and documents regular education programs on correct coding and documentation, using applicable standard professional tools.
- Makes appropriate programs available to physicians, Quality depts, CDI Reviewers, Coders and others as needed.
- Maintains electronic attendance rosters and documentation.
- Makes programs available on-line to the extent available with MLH technology.
Data Trend Analysis
- Analyzes CPT billing patterns, Work queue and denial volumes to identify areas of improvement.
- Monitors coding changes and risk adjustment score changes that could significantly impact data quality and/or revenue.
Management
- Demonstrates positive interpersonal skills.
- Is a role model for staff for attendance, punctuality, and professional appearance.
- Displays excellent communication skills, makes group presentations with confidence.
- Collaborates with MLHC network leadership on provider and employee remediation efforts.
- Develops and maintains up-to-date policies and procedures in conjunction with Coding and CDI Managers.
- Reports operational issues that could affect the quality of documentation or coding. Collaborates with Revenue Cycle, Compliance and HIM management on operational improvement.
Develop and Grow your Career! Invest in furthering your education through seeking certifications or advanced degrees by taking advantage of our Tuition Reimbursement! This position is eligible for up to $6,000 per year based upon your Full or Part Time status.
Position-Specific Benefits include: a number of employee discounts to various activities, services, and vendors... And employee parking is always free!
Position: Director of Ambulatory Documentation Quality and Education
Shift: Days
Experience:• Minimum five years of progressive professional coding or CDI experience.
• Working knowledge of risk adjustment coding and clinical conditions impacting quality outcomes is required.
• Strong understanding of surgical service documentation and coding.
• Previous experience training clinicians is preferred.
Education:• Bachelors degree required
Licensure:• Certified Professional Coder (CPC), Certified Risk Adjustment Coder (CRC).
