Physician Coding Review Specialist

Department:

10417 Enterprise Revenue Cycle - Coding & HIM Support Professional

Status:

Full time

Benefits Eligible:

Yes

Hours Per Week:

40

Schedule Details/Additional Information:

Remote Position

Pay Range

$26.10 - $39.15

Licensure, Registration, and/or Certification Required:

• Coding Associate (CCA) certification issued by the American Health Information Management Association (AHIMA), or
• Coding Specialist - Physician (CCS-P) certification issued by the American Health Information Management Association (AHIMA), or
• Health Information Administrator (RHIA) registration issued by the American Health Information Management Association (AHIMA), or
• Health Information Technician (RHIT) registration issued by the American Health Information Management Association (AHIMA), or
• Professional Coder (CPC) certification issued by the American Academy of Professional Coders (AAPC), or

• Specialty Coding Professional (SCP) certification issued by the Board of Medical Specialty Coding and Compliance (BMSC),

• and

• Specialty Medical Coding Certification issued by the American Academy of Professional Coders (AAPC).

Major Responsibilities:

• Review assigned codes, which most accurately describe each documented diagnosis and/ or procedure according to established CPT, HCPCS, and ICD-10-CM coding guidelines along with modifier usage and medical terminology. Monitor all coding accuracy at various levels of detail and maintain coding quality as needed. Track coding issues and review coding inaccuracies to highlight areas of improvement. Report or resolve escalated issues as necessary.
• Responsible for reviewing Clinician documentation and billed codes for Medical Group physicians and non-physician clinicians. Review of medical records in collaboration with key stakeholders such as Internal Audit, Compliance, and Clinic Operations. Responsible for completing all certified coder quality reviews. Working in collaboration with Coding Production Leads and Supervisors.
• Follows the prospective and/or retrospective review plan to sample employed Clinician's medical record documentation in comparison to services selected for billing, based on best practice methodologies which will be presented and reviewed with Clinicians to provide feedback on proper coding and documentation practices.
• Follows the necessary schedules for team assignments of documentation/coding accuracy. Conducts required, timely reviews per the established Clinician Documentation Review Plan and generates summary reports for Professional Coding leadership and Provider Compliance Committee. Develops mechanisms to identify specific quality issues for each Clinician to allow for focused follow-up reviews to identify improvement/correction of those elements for which the Clinician has received an education.
• Ensures compliance with the system Clinician Documentation Review Plan escalation process for any Clinician who is not successful in meeting the minimum acceptable thresholds. Provides feedback when documentation issues are identified that need improvement. Conducts focused reviews requested by the Compliance department, clinic administration, and Professional Coding leadership. Utilizes monitoring tools or other applications to track and report the progress of the Clinician Documentation & Coding Accuracy Plan and for the evaluation of coding quality standards.
• Identifies, evaluates and acts to resolve any barriers to meeting documentation standards. Provides education/feedback to the department Educators and Coding Liaisons. Maintains coding quality standardized reporting mechanisms. Provides standardized statistical reports of coding quality information to Professional Coding leadership and other appropriate parties.
• Identifies and trends coding quality issues/concerns. Recommends coding accuracy improvement strategies, including continued education and/or training plans. Provides feedback regarding coding guidelines, coding protocols/procedures, and system edits to continually improve coding processes and ultimately the overall coding quality program.
• Conducts scheduled and ad hoc coding quality reviews. Conducts regularly scheduled reviews of encounters where coding has been changed or deleted by Coding team members to ensure accuracy and provide education recommendations. Reviews abstracted and coded encounters for coding accuracy and completeness. Provides feedback on billing system edits