Coding Compliance Coordinator

Job Title

Manage the day to day operations by providing timely, complete, and accurate data collection for optimal reimbursement and quality clinical analysis. Offer coding and documentation guidance to the coders and clinicians to ensure complete documentation within the medical record. Provide ongoing documentation review and analysis to provide coding support to Health First Medical Group (HFMG) Physicians, Clinics, and Hospital-based provider services.

Primary Accountabilities

1. Serve as a resource for annual CPT/HCPCS code updates and charge master validation. Provide education to coders and physicians on changes.

2. Plan, organize, and oversee coding educational activities for coding staff, including Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), Hierarchical Condition Categories (HCC) and current level of International Classification of Diseases (ICD)

3. Knowledge of CPT codes and current ICD-CM codes, as well as, all government and other payer billing and collections rules and regulations as required.

4. Develop standardized workflow processes to ensure standardization throughout team as well as oversee cross-training to assure flexibility and coverage for all department functions.

5. Initiate communications to users of information systems including incidents of change notifications, upgrades, scheduled and unscheduled downtimes.

6. Manage selection, hiring, on-boarding and performance management of direct reports, including goal setting, coaching, developing and evaluating performance to increase workforce capability while achieving department objectives. Communicate and comply with federal, state, governing regulatory and Health First policies and procedures, including by not limited to, people and systems, to minimize risk.

7. Monitor individual and department productivity as well as conduct monthly audits on coders.

8. Communicate effectively at all levels, internally and externally, within the organization, and expressing ideas and information clearly and concisely, in a verbal and written form.

9. Demonstrate knowledge as a Super-user for coding programs that include but not limited to; 3M Encoder, CodeRyte, Athena, SCM, Ingenious Med, and First Access, and other system designated by the organization, and assist in coordinating upgrades, enhancements, education and service.

Work Experience

Minimum Qualifications:

Education: High School diploma or GED

Licensure: None Required

Certification: AAPC Certified Professional Coder (CPC), Certified Coding SpecialistProfessional (CCS-P) Certification, or AAPC Certified Outpatient Coder (COC)

Work Experience: Certified with 5+ years of coding at a professional/Physician level

Knowledge/Skills/Abilities:

Extensive 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 diagnosis codes and procedural codes.

Knowledge in areas health insurance practices, business office operations, financial reporting technology, industry standards for healthcare revenue resolution management practices.

Knowledge of chargemaster structure and encoder/scrubber applications.

Ability to analyze complex clinical scenarios and apply critical thinking.

Proficient in Microsoft PowerPoint, MS Word and Excel.

Preferred Qualifications:

Education: Bachelors Degree

Licensure: None Required

Certification: Medical Coding Certificates for areas of specialization and Certified Risk Adjustment Coder (CRC) preferred

Work Experience: Previous Management Experience

Knowledge/Skills/Abilities: No additional required

Physical Requirements:

Sedentary Office Workers Exerting up to 10 pounds of force occasionally and/or negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects, including the human body. Sedentary work involves sitting most of the time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.

Benefits

At Health First, diversity and inclusion are essential for our continued growth and evolution. Working together, we strive to build and nurture a culture that recognizes, encourages, and respects the diverse voices of our associates. We know through experience that different ideas, perspectives, and backgrounds create a stronger and more collaborative work environment that delivers better results. As an organization, it fuels our innovation and connects us closer to our associates, customers, and the communities we serve.