Consultative Coding Professional
About The Position
The Consultative Coder provides medical coding expertise to support clinical staff (Physicians and Advanced Practice Providers) to ensure the documentation within medical records supports diagnostic and procedural coding. This is a Hybrid role; candidates must reside in South Carolina. You will report to the Director, Medical Coding. You will cultivate relationships with clinicians (Physicians and Advanced Practice Providers) to serve as the single contact for questions and issues relating to documentation and coding. Based on one-on-one engagement with clinicians, identify documentation improvement areas and partner with clinical and coding education to deliver education related to improvement opportunities. Analyze trends, assessment, and answer questions in real-time. Research and interpret correct coding guidelines and internal business rules to respond to inquiries and issues. Perform Quality Assurance on post-visit reviews. You will determine frequency and sampling methodology. Review the encounter for potential missed opportunities. Address non-billable services at the provider level. Address documentation deficiencies resulting in not billable services promptly (missing chief complaint, missing time for audio only visits, and missing telehealth platform). Work with providers to update them on documentation requirements and process changes. Responsible for the special handling of Mergers & Acquisitions: Perform Problem list cleanup (as outlined by compliance). Conduct PCO Process training including reporting for open notes and addendums, and gap attestation process and performance expectations. Train acquired providers on PCO documentation requirements and processes. Lead Special Projects within the Division/Markets. As requested by Market leaders, perform the following tasks: Analyze AWV completion rates (what criteria is needed to complete AWV). Analyze EDAPS; report the variances between datahub and eCW. Conduct Chart reviews to identify educational opportunities. Perform individual chart research. Collaborate with HEDIS leaders and champions to identify HEDIS gaps and deficiencies. Participate in Payer calls/chart reviews. Compile payer findings and assist with research. Participate in payor meetings/discussions to ensure accurate data submission.
Requirements
- Three years Medical Coding experience or similar (including IPA and Offshore coding management)
- Candidate must reside in South Carolina
- RHIA, RHIT, CCS, or CPC Certification
- Self-provided internet service must meet minimum criteria: 25 Mbps download and 10 Mbps upload (wireless, wired cable, or DSL preferred; satellite, cellular, and microwave approved only if used).
- Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
Responsibilities
- Provide medical coding expertise to support clinical staff.
- Ensure medical record documentation supports diagnostic and procedural coding.
- Cultivate relationships with clinicians to serve as a single contact for documentation and coding questions.
- Identify documentation improvement areas through one-on-one engagement with clinicians.
- Partner with clinical and coding education to deliver education on improvement opportunities.
- Analyze trends and assessments, and answer questions in real-time.
- Research and interpret coding guidelines and internal business rules.
- Perform Quality Assurance on post-visit reviews.
- Determine frequency and sampling methodology for reviews.
- Review encounters for potential missed opportunities.
- Address non-billable services at the provider level.
- Address documentation deficiencies promptly.
- Update providers on documentation requirements and process changes.
- Handle Mergers & Acquisitions, including problem list cleanup and PCO Process training.
- Train acquired providers on PCO documentation requirements and processes.
- Lead Special Projects within the Division/Markets.
- Analyze AWV completion rates.
- Analyze EDAPS and report variances.
- Conduct chart reviews to identify educational opportunities.
- Perform individual chart research.
- Collaborate with HEDIS leaders to identify HEDIS gaps and deficiencies.
- Participate in Payer calls/chart reviews.
- Compile payer findings and assist with research.
- Participate in payor meetings to ensure accurate data submission.
Benefits
- medical
- dental
- vision benefits
- 401(k) retirement savings plan
- time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave)
- short-term and long-term disability
- life insurance
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
