Provider Educator

South Shore Health•Weymouth, MA

About The Position

Under the general direction of the Professional Coding Manager, this individual will serve as the subject matter expert and the key point of contact for evaluation and management, procedural CPT and ICD 10 coding documentation information for ProFee coding in the hospital and ASC setting. This person will provide feedback, charge capture concerns and offer suggestions for resolution. Duties include Professional documentation & coding reviews, as well as, collaborating with Compliance and Physician Liaison to address documentation and coding concerns. Specific educational topics to include, but not limited to, documentation specificity requirements, selection of primary and specialty care E&M levels, selection of procedural charges and codes, diagnosis assignment, and modifier assignment to ensure correct coding, legal compliance and complete charge capture.

Requirements

Equivalent to four (4) years of high school education.
Greater than three (3) years ICD10/CPT coding/auditing experience in acute care and medical specialty setting is preferred.
CCS - Certified Coding Specialist or CPC with Certified Professional Medical Auditor
Certified Coding Specialist - American Health Information Management Association (AHIMA)
Certified Professional Medical Auditor (CPMA) - American Academy of Professional Coders (AAPC)

Nice To Haves

Bachelor's degree is preferred.

Responsibilities

Assess professional provider documentation and professional coding education needs by (1) collaborating with the Professional Coding Manager, SSMC Leadership, and Providers to obtain existing data, observations as relates to coding and documentation specificity and (2) by conducting ICD10, CPT, and HCPCS coding and provider documentation audits to evaluate specificity of documentation and corresponding accuracy of assigned diagnosis, procedure, and modifier codes.
Perform provider education using various communication tools and training platforms (e.g., in-person, on-line, one-on-one, and group).
Summarize chart audit results, trends, and corresponding action plans. Distribute and present reports to SSH leadership.
Present education for new providers and present as needed.
Collaborate with SSH leadership, Coders, Billing Staff, Physician Billing Managers and I.S to identify and provide feedback for any new processes, software, and Provider training opportunities based on audit results.
Collaborate with PB Coding Manager to create educational presentations for HealthStream and/or webinars with providers on changing guidelines.
Perform post-presentation quality assurance reviews to assess comprehension of training efforts.
Stay updated on current coding information.
Communicate coding, billing and documentation specificity changes to providers.
Participate in regular meetings with PB Coding Manager and/or the Director of Revenue Integrity to communicate new findings and/or areas of concern.
Provide continual coding and payer update education to providers.
Maintain knowledge of E&M, HCPCS, modifier, ICD10 and CPT classification and coding of diagnoses and procedures.
Assist with developing and implementing recommendations for changes in policies and procedures relevant to correct and compliant provider documentation.
Serve as a resource for physicians, billing, coding, and administrative staff with regard to technical guidance on professional coding/documentation issues.
Complete required continuous training and education to maintain proficiencies.