Performs audits of medical records to assess accuracy and completeness of documentation, adherence to coding rules and regulations, and compliance with reimbursement requirements. Responsible for educating departments on appropriately documenting the medical record for services provided to patients.

DUTIES AND RESPONSIBILITIES:

1. Communicates with department manager, billing staff, providers and other clinic staff regarding coding compliance issues, updates, and errors identified during claims reviews.

2. Conducts quality reviews of coding activities to ensure documentation supports coding rules and coding selection following all coding and billing standards.

3. Performs random medical record auditing and abstraction based on organizational priorities. Provides feedback on audit results and education on how to document appropriately. Identifies trends with provider documentation and coding, support staff performance, and/or system issues which involve multiple sites, departments, and staff members, and addresses those problems with the department manager.

4. Develops and performs training regarding documentation, billing and coding to inform providers of changes/updates in guidelines or activities that prevent denials or increase revenue.

5. Provides education regarding coding, billing and documentation to Business Office staff, providers and clinical staff.

6. Assist EHR Optimization Manager by making recommendations for process improvements to further enhance coding quality goals and outcomes.

7. Remain current on ICD-10 CM coding guidelines, AHA Coding Clinic Guidance and CMS Risk Adjustment guidance.

8. Performs other related duties as assigned.

JOB QUALIFICATIONS:

High school diploma or equivalent

CPC or CCS certification through AAPC or ACDIS, RHIT or RHIA through AHIMA

3+ years as an outpatient CPC or 5+ years in risk adjustment coding/auditing

Knowledge of ICD-10-CM and CPT codes and medical terminology

Advanced knowledge of computerized billing systems

EClinicalWorks EPM, EHR experience is preferred

Experience in the use of personal computers, to include proficiency in Microsoft Word, Excel, Outlook

Bilingual in English and Spanish preferred

Scheduled hours and/or work locations are subject to change

PHYSICAL ACTIVITIES AND REQUIREMENTS:

Finger Dexterity: Using fingers to make small movements such as typing or picking up small objects.

Talking: Frequently conveying detailed or important instructions or ideas accurately, clearly, or quickly.

Hearing: Able to hear average or normal conversations and receive ordinary information.

Repetitive Motions: Frequently and regularly using the wrists, hands, and fingers.

Visual: Average, ordinary, visual acuity necessary to prepare or inspect documents or other materials.

Physical: Limited physical effort required; May have to lift folders, files, papers, audio/video equipment, and other such items weighing up to approximately 25 lbs.

Education

• High School/GED or better in General Business

Licenses & Certifications

• Cert. Professional Coder