Coding Quality Education Specialist

Southwest Network Company Brand•Phoenix, AZ

About The Position

The Coding Quality Education Specialist will audit charts and review clinical records to ensure all diagnostic and procedural codes and modifiers strictly adhere to guidelines. This role involves identifying trends in improper coding or communication shortcomings that could lead to claim denials or audits. The specialist will stay current with medical coding guidelines and monitor evolving regulatory and industry changes. A key responsibility is providing targeted education, direct coaching, and facilitating training programs tailored to specific medical specialties based on audit findings. The role also includes following up with rendering providers for clarification and collaborating with IT and EHR teams to enhance charge automation and workflow optimization. Additionally, the specialist will conduct ad-hoc audits to ensure adherence to coding guidelines and serve as a relevant expert for Southwest Network on accurate and efficient coding practices, analyzing medical records to identify documentation deficiencies.

Requirements

Strict adherence to diagnostic and procedural codes and modifiers.
Identification of trends in improper coding or communication shortcomings.
Compliance with medical coding guidelines.
Monitoring of evolving regulatory and industry changes.
Ability to provide targeted education, direct coaching, and training programs.
Skill in following up and clarifying information with rendering providers.
Collaboration with IT and EHR teams.
Conducting ad-hoc audits.
Expertise in accurate and efficient coding practices.
Analysis of medical records to identify documentation deficiencies.
Adherence to policies and procedures.
Adherence to the requirements of the Corporate Compliance Program.
Ensuring confidentiality of information in accordance with HIPAA standards and Southwest Network policy.
Adherence to legal, ethical, and professional guidelines.

Responsibilities

Audits charts and reviews clinical records ensuring all diagnostic and procedural codes and modifiers strictly adhere to guidelines.
Identifies trends in improper coding or other communication shortcomings that may lead to claim denials or audits.
Complies with all medical coding guidelines and monitors evolving regulatory and industry changes.
Provides targeted education, direct coaching, and facilitates training programs tailored to each medical specialty upon translating audit findings.
Follows up and clarifies any information that is not clear with the rendering provider.
Collaborates with IT and EHR teams to improve charge automation and optimize workflows.
Conducts ad-hoc audits to ensure fidelity to coding guidelines.
Serves as a relevant expert for Southwest Network on accurate and efficient coding practices.
Analyzes medical records and identifies documentation deficiencies.
Follows policies and procedures and adheres to the requirements of the Corporate Compliance Program.
Ensures confidentiality of verbal and written information in accordance with HIPAA standards and Southwest Network policy.
Adheres to the legal, ethical and professional guidelines adopted by Southwest Network.
Performs other duties as assigned.