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Role Description

This position is responsible for conducting coding audits, communicating results and recommendations to providers, management, and executive administration, and providing training and education to providers and ancillary staff. This position will support the implementation of changes to the CPT, CDT, HCPCS and ICD‐10 codes on an annual basis.

• Conduct prospective and retrospective chart reviews (i.e. baseline, routine periodic, monitoring, and focused) comparing medical and/or dental record notes to reported CDT, CPT, HCPCS, and ICD codes with consideration of applicable FQHC and payer/title/grant coding requirements.
• Identify coding discrepancies and formulate suggestions for improvement.
• Communicate audit results/findings to providers and/or ancillary staff and share improvement ideas.
• Work with the Office of the CMO and provider leadership to identify and assist providers with coding.
• Report findings and recommendations to Compliance Officer or designee, management, and executive leadership.
• Provide continuing education to providers and ancillary staff on CDT, CPT, HCPCS, and ICD-10 coding.
• Support compliance policies with government (Medicare & Medicaid) and private payer regulations.
• Perform research as needed to ensure organizational compliance with all applicable coding and diagnostic guidelines.
• Maintain professional and technical knowledge by attending educational workshops and reviewing professional publications.
• Work closely with all departments, including but not limited to, Clinical Services, Nursing, Practice Leadership, Finance, IT, Training, and Billing to assist in accuracy of reported services and with chart reviews, as requested.
• Work with the Purchasing department to order and distribute annual coding materials for all clinical sites and departments.
• Assist Director of Compliance with incidents and investigations involving coding and/or documentation.
• Work closely with all other Compliance personnel to provide coding/compliance support.
• Advise Compliance Officer or designee of government coding and billing guidelines and regulatory updates.
• Provide training to billing coding staff on coding compliance.
• Participate in special projects and perform other duties as assigned.

Qualifications

• High school diploma or equivalent.
• 5 years of healthcare experience.
• 4 years of procedural and diagnostic coding.

Requirements

• AAPC Certified Professional Coder (CPC) certification OR Certified Coding Specialist (CCS) certification through American Health Information Management Association (AHIMA) upon hire.

Knowledge/Skills/Abilities

• Proficiency in correct application of CPT, CDT, HCPCS procedure, and ICD‐10‐CM diagnosis codes used for coding and billing for medical claims.
• Knowledge in correct application of SNOMED, SNODENT, and LOINC.
• Knowledge of medical terminology, disease processes, and pharmacology.
• Strong attention to detail and accuracy.
• Excellent verbal, written, and communication skills.
• Excellent organizational skills.
• Ability to multi‐task.
• Proficient in Microsoft Office Suite.
• Critical thinking/problem solving.
• Ability to provide data and recommend process improvement practices.