JOB SUMMARY:

1.  Project Work 

• Auditing of Coding Edit Resolution
• Auditing of Professional Coding
• Auditing of Facility Coding (ER, OPS, OBS, Ancillary, Recurring Therapy, Clinic, etc.)

2.  Record Keeping                                                              

• Completion of coder audit reports of accounts completed daily
• Completion of Time Allocation reports daily
• Completion of weekly audit reports for assigned staff

3.  Analysis/Reporting                                               

• Identifies trends and reports to Coding manager
• Reports weekly statistics of audits completed
• Develop and coordinate education training programs regarding trends identified

MINIMUM REQUIREMENTS:

• High school diploma
• Five plus years of experience with coding and/or billing in health care revenue cycle.  This should include hospital and physician practice. (additional equivalent educations above the required minimum may substitute for the required level of experience).
• Coding Certifications: The following are recognized professional certifications: Registered Health Information Technician (RHIT); Registered Health Information Administrator (RHIA); Certified Coding Associate (CCA); Certified Professional Coder (CPC); Certified Outpatient Coder (COC); Certified Inpatient Coder (CIC); Certified Coding Specialist (CCS); or Certified Coding Specialist – Physician (CCS-P); Certified Professional Medical Auditor (CPMA). Coding Compliance Specialist team members are required to possess at least one of the above professional services coding certifications.

PREFERRED QUALIFICATIONS:

• An understanding of healthcare billing practices and compliant claims preparation for both governmental and commercial payers.
• Revenue Cycle Certifications:  The following are recognized professional certifications:  Certified Professional Account Representative (CPAR), Certified Revenue Cycle Representative (CRCR) or Certified Professional Biller (CPB).
• Electronic health record (EHR) expertise, including knowledge of a variety of vendors.
• Specialty Coding Certifications:  The following are recognized professional certifications:  Ambulatory Surgical Center (CASCC), Anesthesia and Pain Management (CANPC), Cardiology (CCC), Cardiovascular and Thoracic Surgery (CCVTC), Chiropractic (CCPC), Dermatology (CPCD), Emergency Department (CEDC), Evaluation and Management (CEMC), Family Practice (CFPC), Gastroenterology (CGIC), General Surgery (CGSC), Hematology and Oncology (CHONC), Internal Medicine (CIMC), Interventional Radiology and Cardiovascular (CIRRC), Obstetrics Gynecology (COBGC), Orthopaedic Surgery (COSC), Otolaryngology (CENTC), Pediatrics (CPEDC), Plastics and Reconstructive Surgery (CPRC), Rheumatology (CRHC), Surgical Foot & Ankle (CSFAC), and Urology (CUC).
• Continuing Education Requirements: Medical coders shall maintain the required continuing education hours in order to maintain current and proper national certification(s) requirements for this position.
• Must possess a working knowledge of Medicare and Local Medical Review Policy Guidelines.
• Ability to function independently and as a team player in a fast-paced environment required.
• Knowledge of Evaluation and Management coding.
• Must be able to maintain the company accuracy rating of 95%. 
• Must meet set weekly quota for productivity. 
• Knowledge of the International Classification of Diseases, Clinical Modification (ICD-CM); Healthcare Common Procedure Coding System (HCPCS); and Current Procedural Terminology (CPT).
• Knowledge of reimbursement systems, including Prospective Payment System (PPS); Ambulatory Payment Classifications (APCs); and Resource-Based Relative Value Scale (RBRVS).
• Practical knowledge and understanding of industry nomenclature; medical and procedural terminology; anatomy and physiology; pharmacology; and disease processes.
• Practical knowledge of medical specialties; medical diagnostic and therapeutic procedures; ancillary services (includes, but is not limited to, Laboratory, Occupational Therapy, Physical Therapy, and Radiology).
• Make well-informed, effective, and timely decisions, even when data are limited or solutions produce unpleasant consequences; perceives the impact and implications of decisions.
• Utilize medical computer software programs to abstract, analyze, and/or evaluate clinical documentation and enter/edit diagnosis, procedure codes and modifiers.
• Clearly express information (for example, ideas or facts) to individuals or groups effectively, taking into account the audience and nature of the information.
• Display courtesy, empathy, and tact, developing and maintaining effective relationships with others; effectively work with individuals who are difficult, hostile, or distressed to resolve differences; and be able to relate well to people from varied backgrounds and in different situations.
• Work with internal and external customers to assess their needs, provide information or assistance, resolve their problems, or satisfy their expectations.
• Contribute to maintaining the integrity of the organization; display high standards of ethical conduct and understand the impact of violating these standards on an organization, self, and others.
• Be open to and embrace change and new information; adapt behavior or work methods in response to new information, changing conditions, or unexpected obstacles; effectively deals with uncertainty.  Cooperate by willingly accepting new assignments, and forming relationships with customers/co-workers/supervisors.
• A high level of effort and commitment towards performing the work, using efficient learning techniques to acquire and apply new knowledge and skills; uses training, feedback, or other opportunities for self-learning and development.
• Understand and interpret written material, including technical material, rules, regulations, instructions, reports, charts, graphs, or tables; applies what is learned from written material to specific situations. Working Excel knowledge. 
• Attention to detail and completeness with a thorough understanding of government rules and regulations, medical coding and reimbursement guidelines, and potential areas of risk for fraud.
• Work planning is necessary in being able to understand assignments and establish priorities.  It is required that each coder be able to look at his/her work load and determine priorities for the day. 
• Ability to respond to email or text correspondence in a timely manner.