Coding Compliance Specialist

La Clinica Del Valle•Medford, OR

3d•Onsite

About The Position

The Coding Compliance Specialist’s primary job function is to maintain organizational compliance with coding and medical record documentation. The Coding Compliance Specialist is responsible for reviewing the coding of professional service records for compliance with CMS, AMA and certified coding standards. This position will conduct internal chart audits, encounter form reviews, assist with teaching providers/staff coding, and reporting results. This position will support any third-party billing staff in areas related to coding and/or collections. Utilizes advanced knowledge of specialty coding to analyze patient medical records, ensuring that documentation by providers conforms to legal and procedural requirements.

Requirements

Minimum: High School Diploma or GED equivalent.
Certification in ICD-10, CPT and HCPCS coding is required.
Minimum one year experience working with Electronic Health Record and specialty coding with one to three years’ experience directly related to the duties and responsibilities field.
Excellent interpersonal communication and problem-solving skills.
Skills to intervene and promote reconciliation, compromise and positive outcomes in difficult interactions.
Skilled at using electronic health records as applicable to area of work (EPIC, Wisdom).

Nice To Haves

Additional education and training are desirable with two years medical office experience and training; billing experience and chart auditing experience preferred.
Community health care experience preferred.
Basic knowledge of adult learning models.

Responsibilities

Ensure that medical claims are submitted accurately and in a timely manner.
Review electronic health record to assign accurate ICD-10-CM and CPT/HCPCS codes based on coding principles and official guidelines.
Reviews patient records documentation to ensure that services provided are accurate and meet appropriate guidelines.
Monitors billing performances to ensure optimal reimbursement while adhering to regulations prohibiting unbundling and other questionable practices.
Utilizes advanced, specialized knowledge of medical codes and coding procedures to assign and sequence appropriate diagnostic/procedure billing codes, in compliance with third party payer requirements.
Interacts with physicians and other patient care providers regarding billing and documentation policies, procedures, and regulations; obtains clarification of conflicting, ambiguous, or non-specific documentation.
Reviews and resolves the claim edit and charge review work queues.
Enter out-patient/hospital physician/non-physician practitioner services through review of medical records/encounter forms or EHR records. Will also review recipient identification to assure correct patient.
Provides feedback and education regarding identified deficiencies to providers and clinical staff.
Serves as a resource person to providers, clinical, and coding staff on problems related to coding.
Assists in developing, implementing, and processing a coding compliance education/training program for physicians, on-physician providers, and new providers.
Processes rebilling’s as requested/required by insurance rejections for coding errors.
Assures compliance with all regulatory agencies and payor sources.
Conducts quarterly compliance auditing and monitoring for all payors. Creates summary of findings to report to leadership with solutions to address issues with employees.
Communicates with providers and clinical coordinators/team leads regarding new regulatory guidelines for billing and documentation compliance.
Assures that providers and support staff understand their responsibility for accuracy of coding of encounters.
Leads or assists in developing education programs for providers around coding.
Acts as a liaison between physicians and clinical staff to resolve issues involving coding and documentation requirements and procedures.
Research inquiries from providers and patients related to coding, reimbursements, and denials.
Responds to inquiries regarding CPT, HCPCS and ICD-10 coding.
Acts as a liaison between the medical coordinators, members of senior leadership, and the coding department.
Works with OCHIN billing service to remedy coding issues.
Interacts with department heads and other administrative staff regarding implementation of new codes and revision of charge documents.
Complies with patient records policies and procedures such that patient data is handled in a strictly confidential manner; protected from loss, tampering, destruction, or unauthorized disclosure.
Ensures the integrity of the HCPCS, CPT and ICD-10 codes are maintained in the electronic health record (EHR).
Follows established departmental policies, procedures, and objectives, continuous quality improvement objectives, and safety and environmental standards.
Attends coding conferences, workshops, and in-house sessions to receive updated coding information and changes in coding and/or regulations.
Maintains fee schedules and provider master file.
Participates in OCHIN Billing Workgroup. Acts on information and communicates changes as appropriate.
Maintains current coding credentials and knowledge of state and federal regulations applicable to coding.