The Coding Compliance Consultant performs CPT coding audits as well as other projects related to physician coding compliance including educating physicians and clinic staff on proper clinical coding and documentation standards and rules. The Consultant will demonstrate a thorough understanding of complex coding, reimbursement, and health information management processes, and auditing principles as they relate to physician practice and clinic settings. In addition, the consultant will communicate with the department leadership regarding complex coding and auditing issues and current coding regulations and keep informed regarding current coding regulations, professional standards and company/department policies and procedures and effectively applies this knowledge.
Manage, direct and supervise coding and compliance activities including securing, maintaining and distributing the most current coding and compliance information and implementing changes.
Reviews and evaluates coding and compliance issues and concerns.
Ensures that all administrative, management, providers and staff are in compliance with the rules and regulations of regulatory agencies and with company policies, procedures and the company’s Standards of Conduct
Train and educate, coding review of partner’s medical documentation, responding to coding-related queries, analysis of coding data, and development of coding-related content.
Implements audit engagements including scheduling and undertaking audit fieldwork with minimal supervision.
Analyzes medical records and coding and documentation information, identifies issues, reaches conclusions, and proposes strategies for resolution of complex coding issues.
Prepares working papers, reports and memoranda regarding audit results and coding compliance matters.
Maintains spreadsheet data related to coding and documentation compliance and trending.
Communicates effectively with operations personnel and company leadership regarding coding and documentation compliance matters.
Works with employed physicians and practice staff to educate, train and improve practice coding and documentation.
Provides input and guidance in the development and review of detailed audit programs and reports to improve audit effectiveness and efficiency.
Undertakes continuous education to maintain technical coding, HIM, auditing and management skills consistent with the company and department’s professional development requirements and individual credentials.
Bachelors Degree or 5 years experience of Physician Coding
One or more of the following certifications (or eligibility therefore):
Ability to travel up to 70% of the time.
Experience managing multiple simultaneous clients or projects with a high level of attention to detail
Minimum 3 years experience working in a physician coding-related position
3+ years of consulting, auditing or coding education experience
Ability to communicate effectively both written and verbal
ICD-10 certification from AHIMA
Knowledge of CMS physician fee schedule methodology and its associated regulations
Familiarity with analytics and indicators used to measure and monitor coding performance
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