Ambulatory Coding Auditor / Educator

Signature Healthcare is Southeastern Massachusetts’ premier local provider of quality, personalized medical services. We are comprised of the award-winning not-for-profit Signature Healthcare Brockton Hospital; Signature Medical Group (SMG), a multi-specialty physician group of more than 150 physicians practicing in 18 ambulatory locations. We believe our distinctive Signature Healthcare team approach is the way healthcare should be : medical professionals across many locations communicating and collaborating, taking advantage of technologies and resources to make a difference in the lives and health of our patients.

Position Summary :

Under the general direction of the Corporate Director, Health Information Management & Privacy Officer provides leadership and technical support for ambulatory coding auditing and educating functions. Responsible for ensuring accurate diagnosis and procedure coding as well as providing documentation and coding related feedback and educational services to providers.

Location : West Center Street, West Bridgewater, MA

Department : Health Information

This is a full-time 40 hour / week position.

Responsibilities :

Demonstrates respect and regard for the dignity of all patients, families, visitors, and fellow employees to ensure a professional, responsible, and courteous environment.

Commits to recognize and respect cultural diversity for all customers (internal and external).

Communicates effectively with internal and external customers with respect of differences in cultures, values, beliefs and ages, utilizing interpreters when needed.

The Ambulatory Coding Auditor / Educator is an internal resource to clinicians by providing training, consultation, audit and coordinated feedback on their medical service documentation and coding to ensure that Signature Healthcare receives appropriate reimbursement and conforms to applicable guidelines and regulations.

Performs medical record audits to ensure compliance with all applicable coding regulations as well as with organizational standards, practices, policies, and procedures.

Provides elbow-to-elbow coding and documentation support through ad hoc phone calls, site visits, the creation of specialty or individual provider tip sheets, virtual and on-site presentations.

Serves as subject matter expert with specialty-specific knowledge of surgical, E&M, diagnosis coding & documentation. Analyzes data, communicates findings, and facilitates improvement efforts.

Independently develops and maintains educational materials and training programs.

Works in conjunction with the practice managers and production coding leadership teams.

This position may require on-site work to interact with physicians with potential for remote work as directed by manager.

Performs other duties as assigned

BASIC KNOWLEDGE / SKILLS / APTITUDE / EXPERIENCE :

Ability to solve practical problems and deal with a variety of variables in situations where only limited standardization may exist.

Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.

Must be able to reasonably make appropriate judgment in communications and actions with patients, physicians, other associates, outside agencies, and vendors.

Comprehensive knowledge of CPT coding methodologies and regulatory requirements.

Utilizes strong knowledge of anatomy, physiology and medical terminology to ensure professional claims are billed with the appropriate CPT4, ICD10CM, and HCPCS codes and modifiers when applicable.

Ability to converse with physicians regarding coding and documentation.

Advanced knowledge of official coding conventions and rules established by the American Medical Association (AMA), and the Center for Medicare and Medicaid Services (CMS) for assignment of diagnostic and procedural codes.

Requires some travel to meet with and educate providers in hospital or clinic locations

Education / Experience / Licenses / Technical / Other :

Education : Associate Degree required; BA Preferred

Experience (Type & Length) : 5 or more years in Ambulatory or Hospital Outpatient. A minimum of three to five years coding experience (ICD-10-CM, CPT) in an ambulatory setting required.

Certification / Licensure : ( CPC, CCS-P, COC [at least one] and CPMA, (CDEO, CEMC preferred) and ICD10CM Certification or ICD10CM Proficiency required.

Software / Hardware : Experience and familiarity with electronic health record systems, RCX, 3M and Microsoft Office.

Other : 3 years extensive auditing experience with demonstrated ability to provide effective analytical problem solving. 2 + years of multispecialty professional services coding experience assigning evaluation & management codes. 2 years’ experience with project management functions and presenting education and training feedback to small and large groups, especially to physicians or other clinical providers.