CODING AUDITOR/EDUCATOR - CMG

Overview:

The CMG Professional Coder demonstrates excellent customer service performance in that his/her attitude and actions are at all times consistent with the Vision, Mission, and Values of Covenant and the commitment to Extraordinary Care for Every Generation. Responsible for review and analysis, including, but not limited to, medical coding and third party payor documentation and reimbursement analysis. This position also coordinates and/or provides ongoing medical documentation and coding educational programs to network physicians, management and staff. Maintains established organization and department policies, procedures, objectives, quality assessment, and safety. Responsible for assisting in maintaining a safe working environment throughout the organization, adhering to all safety management policies and procedures. Attends all mandatory in-service programs and maintains professional education requirements.

Responsibilities:

Demonstrates excellent customer service.

Contributes to Organizational success targets for patient satisfaction.

Assure all communications via telephone, in person or written are timely, tactful, effective, positive, and professional.

Formulates and uses effective working relationships with all members of the CMG Department, physicians, external customers, patients and other staff members or departments encountered.

Demonstrates competency in utilizing the computer functionality to perform job duties.

EMR, email/Lotus Notes, internet, other software as needed (Krono’s, Word, Excel, Intelicode, Systoc, etc.)

Adhere to coding rules for coding professional services for multiple specialties (neurosurgery, pediatric surgery, rehab, cardiology, etc.), urgent care, occupational health, family practice and other to ensure quality coding based upon documentation within the patient record.

Follows policies, procedures and guidelines to assure consistent coding quality. At the same time utilizes analytical skills when reviewing charts, interrupting documentation and applying codes, sufficing edits, etc.

Assures coding is completed timely and all work queues are maintained at a reasonable completion rate/turn around timeframe. This includes the willingness to help others, accepting help from others and the ability to work extra when backlogs occur.

Participates in CMG Department Meetings and area specific meetings (Professional coding, Practice Managers, Billing, routine specialty, clinical areas, residents/physician meetings, etc.) as required.

Assist in achieving departmental, AR and area specific goals.

Charge entry for professional services (office and/or hospital based for acute care, urgent care, specialty care, occupational health, skilled nursing, etc. services).

Supports physicians, leadership, managers and staff on coding and documentation related items. Problem solves, researches topics, makes recommendations and provides education as needed.

Performs E&M, procedural or other specified coding audits for many professional settings and services.

Develops training or education materials for staff use.

Helps to identify solutions to problems and assists in resolving issues related to coding.

Shares knowledge during training of new staff and is a resource to others.

Independent learning with desire for continued personal and professional growth. Stays current on coding updates and publications.

Maintain a central library with current books and other publications related to medical coding and documentation.

Required to provide written and oral feedback to providers on audits, for education, or other as required.

Assist CBO/Finance/Data/Other as requested for follow up on items related to coding, billing or reimbursement.

Assure that all legal requirements, including Federal (HIPAA) and State regulations are met.

Demonstrates an awareness of legal/confidentiality issues and adheres to all HIPAA Privacy and Security, and Department Policies and Procedures.

Maintain records and documentation of reviews preformed for each provider and prepares trend analyses to evaluate coding and documentation performance over time and to measure improvements.

Participates in development and attainment of department and workgroup goals.

Assist with special projects related to Network improvement.

Prepare and submit to the Network Executive a monthly report of all summary findings, identifying the strengths and weaknesses of individual provider performance related to compliance with medical coding and documentation guidelines.

Qualifications:

EDUCATION/EXPERIENCE

Required – Certified Professional Coder (CPC) or associates degree/certification in medical curriculum with two years coding experience in a professional setting. May substitute two years ICD-9-CM & CPT 4 coding experience with understanding that the Certified Professional Coder (CPC) requirement be fulfilled within 18 months of the start date.

Preferred experience in a professional coding setting / physician office setting.

C oding experience preferred utilizing ICD-9-CM and CPT4 coding books and references in a professional setting.

M ust be able to tolerate working under stress, limited time constraints and with frequent interruptions and deadlines.

P referred 3-5 years experience in medical reimbursement. A working knowledge of ongoing trends in health care and governmental regulation is strongly desired.

KNOWLEDGE/SKILLS/ABILITIES

Basic Computer skills including the ability to search for work related items on line using the internet.

K nowledge of standard office equipment.

K nowledge of computer use.

D emonstrates knowledge of ICD-9-CM diagnosis coding, CPT-4 coding and HCPCS coding guidelines.

K nowledge / understanding of medical terminology and anatomy.

M aintains professional credentials.

K nowledge of third party payer coding and billing reimbursement.

D emonstrates effective communication methods and skills, both verbally and in writing.

U ses appropriate organization/priority setting skills to complete work timely and accurately.

P ractices effective problem identification and resolution skills as a method of sound decision making.

Demonstrates interpersonal skills required to work with many other people and personalities.

R equires the ability to use sound judgment, based upon the latest guidelines, federal and state statutes and regulations, as well as hospital and departmental policies

C ontinued growth in many areas.

A bility to sit and look at computer screen for long periods of time.

T o use a computer, mouse, learn different software applications and references required to complete the job tasks.

B e flexible to adjust assignments as priorities change. Frequent travel to physician practices and occasional after hours meetings required.

A bility to work with various staff levels and maintain positive working relationships.

A bility to communicate effectively both verbally and in writing.

Must be professional, self-motivated, and work independently with the ability to make sound decisions, analyze issues and solve problems

WORKING CONDITIONS/PHYSICAL DEMANDS

Ability to maintain punctual attendance consistent with the ADA, FMLA, and other federal, state, and local standards

Constant sitting, handling, feeling, hearing and near vision

Frequent lifting up to 10 lbs.

Frequent midrange vision, far vision, depth perception, color vision and field of vision

Occasional lifting up to 50 lbs.

Occasional standing, walking, lifting, carrying, pushing, pulling, climbing, balancing, stooping, kneeling, crouching, squatting, crawling, twisting, reaching, handling and talking