Coding Resource Advisor

Billings Clinic•Billings, MT

About The Position

The Coding Resource Advisor serves as the principal resource for documentation, coding, and reimbursement research and education for Billings Clinic providers, staff, and leadership. The role educates physicians and other staff on revenue-cycle practices, including clinical documentation, coding, reimbursement, denials, and appeals, and helps maximize appropriate reimbursement through education and auditing. The advisor analyzes coding distribution and clinical denial trends, interprets payer bulletins and regulations, researches billing methodologies for new procedures and technologies, and works with Reimbursement, Information Services, and Clinic leadership on coding compliance and charge-entry systems. The position coordinates coding, reimbursement, compliance, and internal audits; reviews records for coding and documentation compliance; and communicates coding and billing changes. It also researches new technologies and service lines, works with vendors on reimbursement for new products and equipment, and helps keep charge masters, fee structures, and electronic charge-capture tools accurate. The advisor codes and abstracts diagnoses and procedures from inpatient and outpatient patient records using ICD and CPT/HCPCS codes for statistical and reimbursement purposes, responds to questions from leadership and staff, and performs other assigned duties or projects.

Requirements

High school graduate or equivalent.
At least two years of experience in a multispecialty clinic and/or hospital working with ICD-CM, CPT-4/HCPCS, and/or DRG coding.
Demonstrated experience in a clinical setting performing technical responsibilities related to ICD-CM, CPT-4/HCPCS coding, fees, and reimbursement.
Ability to understand and develop information using databases and create complex spreadsheets.
Intermediate knowledge of Microsoft Office, including Word, Excel, and PowerPoint.
At hire, hold a credential such as RHIT, RHIA, CPC, CCS, or another recognized AAPC or AHIMA credential.

Responsibilities

Educate staff, particularly providers, on accurate documentation, coding, billing, and reimbursement.
Coordinate and complete coding, reimbursement, compliance, and internal audits, including assigned monitoring activities.
Audit data and records to ensure coding and documentation meet established standards and regulatory requirements.
Review, analyze, interpret, and disseminate coding changes, billing regulations, and government and third-party payer policies and updates.
Appeal payer policy changes when appropriate.
Research and audit new technologies and service lines for compliant coding and documentation requirements, in conjunction with reimbursement information.
Meet with equipment and drug vendors to support appropriate reimbursement for new equipment and products.
Coordinate regular charge-master updates, participate in annual CDM/code reviews, identify fee-structure enhancements, and ensure electronic charge-capture tools are accurate.
Code and abstract diagnoses and procedures from patient charts using ICD and CPT/HCPCS codes for statistical and reimbursement purposes for inpatient and outpatient services.
Research and respond to questions from Billings Clinic leadership and staff.
Work with the Reimbursement department, Information Services, and Billings Clinic leadership on charge-entry systems, coding compliance, the Cerner charge build, fee schedules, and identification of high-risk areas.
Support and model behaviors consistent with Billings Clinic’s mission, vision, values, code of business conduct, and service expectations; meet organizational and departmental requirements and maintain required competency.
Perform other duties and special projects as assigned or needed.