Professional Coding Audit & Education Specialist

EvergreenHealth•Kirkland, WA

13d•$32 - $52•Hybrid

About The Position

Responsible for independently performing coding reviews and audits to assess coding accuracy, documentation improvement opportunities, and mitigate organizational risk. Provides detailed and timely audit reports to providers and leaders. Acts as subject matter expert in professional coding including CPT, ICD-10-CM, and HCPCS. Develops and presents customized education for professional coding, documentation guidelines, payer reimbursement rules and regulations. Creates and presents customized coding training for new physicians, advanced practice providers and production coders. Travels to clinic locations to build and maintain relationships with physicians, advanced care providers and other clinical staff as needed. Provides classroom and/or individual education as requested. Advises the professional billing office regarding billing compliance concerns and recommends appropriate guidance. Develops written coding guides, training documents, and updates. Identifies and investigates potential compliance risks related to coding in collaboration with the Professional Coding Manager and Compliance Officer.

Requirements

High school diploma or G.E.D
Current professional coding credential: AAPC (Certified Professional Coder [CPC], Certified Outpatient Coder [COC]), PMI (Certified Medical Coder [CMC]), or AHIMA (Certified Coding Specialist-Physician [CCS-P], Certified Coding Associate [CCA], Certified Coding Specialist [CCS], Registered Health Information Administrator [RHIA], Registered Health Information Technician [RHIT])
One year of professional coding experience in a multi-specialty medical group setting.
Extensive knowledge in ICD-10, CPT and HCPCS coding for professional services.
Proficient knowledge of medical terminology and coding and sequencing guidelines.
Comprehensive understanding of anatomy, physiology and disease processes.
Expanded understanding of payer billing requirements.
Excellent written and verbal communication skills

Nice To Haves

Five years coding experience and/or one to three years performing documentation audits in a multi-specialty medical group setting.
AAPC specialty surgical certification(s): Certified Professional Medical Auditor [CPMA], Certified Evaluation & Management Coder [CEMC], Certified Cardiology Coder [CCC], Certified Cardiovascular and Thoracic Surgery Coder [CCVTC], Certified Gastroenterology Coder [CGIC], Certified General Surgery Coder [CGSC], Certified Interventional Radiology Cardiovascular Coder [CIRCC], Certified Obstetrics Gynecology Coder [COBGC], Certified Ophthalmology Coder [COPC], Certified Orthopedic Surgery Coder [COSC], Certified Urology Coder [CUC]).

Responsibilities

Independently performs highly complex and detailed coding reviews and audits to assess coding accuracy, documentation improvement opportunities, and mitigate risk.
Completes documentation audits and provides detailed and timely audit reports to providers and leaders.
Acts as subject matter expert in professional coding including to provide feedback and accurate guidance to physicians, advanced practice providers, professional billing staff, clinic staff, and clinic leaders.
Develops and presents customized education for professional coding, documentation guidelines, payer reimbursement rules and regulations for physicians and advanced practice providers based on documentation audit findings.
Creates and effectively presents customized coding training for new physicians, advanced practice providers and production coders.
Periodically travels to clinic locations to build and maintain relationships with physicians, advanced care providers and other clinical staff and provide coding and documentation education as needed.
Provides classroom and/or individual education to clinic managers, support staff, production coders, professional billing staff and others as requested.
Advises the professional billing office regarding coding compliance concerns and recommends appropriate guidance.
Develops written coding guides, training documents, and updates regarding coding and regulatory changes for physicians, advanced practice providers, coding staff, clinic staff and the professional billing department.
Suggests potential areas for improvement to meet organizational policies and procedures.
Identifies and investigates potential compliance risks in collaboration with the Professional Coding Manger and Compliance Officer.