Coding Quality Education Specialist
About The Position
The Coding Quality Education Specialist will audit charts and review clinical records to ensure strict adherence to all diagnostic and procedural codes and modifiers. This role involves identifying trends in improper coding or communication issues that could lead to claim denials or audits, and ensuring compliance with medical coding guidelines while monitoring regulatory changes. The specialist will provide targeted education, direct coaching, and training programs tailored to specific medical specialties based on audit findings. They will also follow up with rendering providers for clarification, collaborate with IT and EHR teams to enhance charge automation and workflow optimization, conduct ad-hoc audits, and serve as a relevant expert for Southwest Network on accurate and efficient coding practices. Additionally, the role includes 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 all medical coding guidelines
- Monitoring of evolving regulatory and industry changes
- Provision of targeted education, direct coaching, and training programs
- Follow-up and clarification with rendering providers
- Collaboration with IT and EHR teams
- Conducting ad-hoc audits
- Expertise in accurate and efficient coding practices
- Analysis of medical records for documentation deficiencies
- Adherence to 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
- 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 medica specialty upon translating audit findings
- Follows up and clarifies any information that i s 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
- Relevant expert for Southwest Network on accurate and efficient coding practices
- Analyze medical records and identify 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, and adheres to the legal, ethical and professional guidelines adopted by Southwest Network
- Other duties as assigned
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
