Job Description

Major Responsibilities:

• Provides service line/specialty specific coding/documentation education and feedback related to coding changes (CPT including E&M, modifiers, ICD-10-CM, and HCPCS), annual code updates, payer requirements, and payer rejection resolution to assigned Physicians/APCs. Partners with CMOs to standardize coding processes across a specific specialty. Shares and/or presents coding/documentation education presentations to Chief Medical Officers (CMOs), Physicians/APCs, Senior Director Administrators across the organization. Coordinates with PSA Liaisons to provide adequate Physician/APC and/or clinical team member support.
• Conducts orientations for all Physicians/APCs, residents/students and clinical team members on specialty specific coding and documentation related education. Performs new clinician documentation reviews for specialty specific coding, and documentation feedback, as requested.
• Coordinates responses to Physicians/APCs, Locum Tenens, residents/student's questions and feedback from various sources and partners, including Senior director administrators, CMOs, Medical Group Compliance, Internal Audit, Physician Compensation, Clinical Informatics/Clinical Informatics Educators, Quality Improvement Coordinators, and/or other external partners.
• Queries Physician/APC, Locum Tenens, residents/students when prompted by Professional Coding Department production coders to assist in resolving coding and documentation questions. Relays any coding changes, feedback, and education to Physician/APC, Locum Tenens, residents/students and/or clinic leadership, as appropriate.
• Monitors and works to resolve charge sessions requiring additional information for assigned clinicians and/or service line/specialty in the Epic work queues and/or other transfer work queues to ensure Clinicians are completing work timely to ensure proper supporting documentation for billing and timely filing.
• Attends and provides service line/specialty specific coding and documentation information, as requested, to CMOs, Physicians/APCs and/or Clinic/Site Department meetings. These may be virtually and/or in-person. Virtually attends Physician/APC education that include coding and/or documentation topics, such as Documentation Specialist clinician low risk review meetings, Risk Adjustment/HCC meetings, and/or Medical Group Compliance reviews/meetings.
• Collaborates with PSA Liaison to review and provide coding/documentation guidance on Epic order entry, diagnosis, and charge capture preference lists as well as SmartSets and templates.
• Develops Physician/APC monthly service line/specialty newsletters to continually educate and communicate updates from various coding resources including specialty society organizations. Communicates new services performed by Physician/APCs to Professional Coding department leadership.
• Identifies service line/specialty specific trending data and opportunities to capture revenue through documentation improvement. Attends service line/specialty specific coding and/or society conferences, as requested, to gain further knowledge that is uniquely relevant to that specialty and how coding, documentation, and billing are affected. Maintains expert knowledge of Medicare, Medicaid, and other regulatory requirements pertaining to nationally accepted coding policies and standards.

Licensure, Registration, and/or Certification Required:

• Coding Associate (CCA) certification issued by the American Health Information Management Association (AHIMA), or
• Coding Specialist - Physician (CCS-P) certification issued by the American Health Information Management Association (AHIMA), or
• Health Information Administrator (RHIA) registration issued by the American Health Information Management Association (AHIMA), or
• Health Information Technician (RHIT) registration issued by the American Health Information Management Association (AHIMA), or
• Professional Coder (CPC) certification issued by the American Academy of Professional Coders (AAPC), or
• Specialty Coding Professional (SCP) certification issued by the Board of Medical Specialty Coding and Compliance (BMSC), and
• Specialty Medical Coding Certification issued by the American Academy of Professional Coders (AAPC) needs to be obtained within 1 year.

Education Required:

• Advanced training beyond High School that includes the completion of an accredited or approved program in Medical Coding Specialist.

Experience Required:

• Typically requires 5 years of experience in expert-level professional coding and least 3 years educating/training licensed clinicians.

Knowledge, Skills & Abilities Required:

• Specialty Medical Coding Certification must be held in the area(s) you will support.
• Excellent communication (oral and written), adult education, and interpersonal skills. Ability to develop rapport and maintain positive, professional partnerships primarily with employed Physicians, APCs, CMOs, Senior director administrators, Medical Group Operations, and physician coding team members.
• Advanced computer skills including the use of Microsoft office products, electronic mail, video/web conferencing, including exposure or experience with electronic coding and EHR systems or applications.
• Excellent/comprehensive skills in organization, prioritization, problem solving, facilitation skills as well as the ability to have meaningful, albeit, difficult conversations with CMOs/Physicians/APCs and/or Senior Director Administrators.
• Highly proficient in critical thinking and analytical skills with an extensive attention to detail.
• Ability to work independently and exercise independent judgment and decision making.
• Ability to meet deadlines while working in a fast-paced environment.
• Ability to work in multiple work environments (ie virtual, office, clinic/hospital, other).

Physical Requirements and Working Conditions:

• Exposed to normal office environment.
• Position requires travel which will result in exposure to road and weather hazards.
• Operates all equipment necessary to perform the job.

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.

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