Provider Coding and Informatics Educator (Outpatient)

Provider Coding And Informatics Educator

Under the direction of the Director of Business Office Operations (DBOO), this position will review and analyze provider documentation related to diagnoses, procedures, and treatments within the electronic health system to identify opportunities, improvements, and barriers in charge automation and information exchange. This role will identify the appropriate systems and/or processes to optimize the use of information technology that support interface enhancements in the outpatient healthcare setting. This position will review, design, and provide in-person education and training to providers related to assigning ICD-10 and CPT coding, ensuring compliance with Federal, State, and payer regulations and understand the technology processes to enhance charge capture and decrease revenue leakage. The Provider Coding and Informatics Educator will develop education based on provider specialty and location and serve as the primary resource to providers for documentation and coding issues.

Qualifications

Preferred/Required Education

• High school diploma or equivalent required
• Certified Coding Specialist (CCS), Certified Professional Coder (CPC) required

Preferred/Required Experience

• Minimum of four (4) years' experience outpatient medical coding, preferably for a Level One and Teaching Hospital, Multi-Specialty outpatient facility
• Experience in Revenue Cycle Management (medical billing) preferred
• Two (2) years' experience clinical documentation improvement, chart review, and coding physician services
• Prior experience with Athena/IDX, EPIC, Encoder Pro preferred

Functions

• Provide clinical documentation review and clinical information systems education to support accurate coding and regulatory compliance.
• Identify patterns, trends, variations, and barriers in coding and documentation practices to ensure all care delivery services are accounted for in health information exchange and charge automation.
• Work closely with information systems regarding charge automation and technology enhancements.
• Attend and provide coding and documentation information sessions to Physician/Provider and Clinic/Site Department meetings.
• Conduct Physician/Provider education that include coding and/or documentation topics, such as documentation by Specialist Provider, online review meetings, and Revenue Cycle Management division meetings.
• Review and provide coding and/or documentation guidance; initiates updates to record or EMR templates.
• Communicate Physician/Provider new services to DBOO and/or Revenue Cycle Management and facility EMR partners
• Identify and/or prompt clinical documentation improvement (CDI) and charge capture efficiency and opportunities.
• Independently support and maintain Physician/Provider, RCM, and facility informatics relationships as the point of contact.
• Maintain current knowledge of Medicare, Medicaid, and other regulatory requirements pertaining to nationally accepted coding policies and standards.
• Take ownership of special projects, research data and follows through with detailed action plans.
• Analyze interface information to enhance charge capture.
• Design, develop, and deliver education programs, including training and support materials, tailored to provider specialty and applications.
• Analyze and report on charting processes.
• Collaborate with educators and subject matter experts.
• Collect and coordinate the collection of data by performing coding quality chart reviews, ensuring the reviews meet government, regulatory, and coding guidelines/standards.
• Deliver chart review results with accurate and relevant reports that can be used to make informed business decisions.
• Other duties as assigned.

Role-Specific Knowledge, Skills, and Abilities

• Extensive knowledge in ICD-10-CM and CPT coding, guidelines, anatomy, physiology and medical terminology
• Ability to exercise initiative and problem-solving skills
• Strong critical reading and comprehension skills
• Ability to read, understand and follow oral and written instructions
• Must be well organized and detail oriented
• Must be able to work under pressure and meet deadlines, while maintaining a positive attitude
• Must be able to effectively educate and train both in-person and virtually
• Knowledge of Medicare/Medicaid and other government regulations surrounding documentation, coding, and medical billing practices
• Ability to understand the clinical content of medical records and technology platforms
• Have excellent communication, documentation, and presentation skills to interact and communicate effectively with providers and other staff
• Ability to explain information in a clear, concise, and organized format
• Ability to manage time efficiently and multi-task expectations and responsibilities
• Position is required to be present on DMG or Valleywise location(s) to complete job duties such as in-person training