[Hiring] Professional Coding and Documentation Improvement Specialist @Capital Health (US)

Role Description

Facilitates compliant physician coding and documentation for accurate assignment of diagnosis, Evaluation and Management (E&M) and Current Procedural Terminology (CPT) codes. Performs ongoing monitoring of medical record documentation content to ensure all industry guidelines, laws and regulations are met. Performs provider feedback and education on proper documentation to support code level selections. Identifies and reports recurring coding and documentation improvement areas to leadership to review and respond. Reviews and responds to requests for coding and documentation education. Supports proactive documentation improvement initiatives within Capital Health Medical Group (CHMG).

Qualifications

• High School Diploma or equivalent.
• Associate's degree in health information management preferred.
• Certified Professional Coder (CPC) or Certified Coding Specialist-Physician-based (CCS-P) required.
• Physician coding and Training certification.
• Two years’ experience in professional coding role, monitoring and education experience preferred.
• ICD-10-CM, CPT, CM, and HCPCS coding experience.
• Excellent verbal and written communication skills.
• Knowledge of pathophysiology and disease processes.
• Strong knowledge of industry guidelines and laws for physician coding and reimbursement.
• Possesses research and analysis skills.
• Proficient with Microsoft applications to include Outlook, Word, Excel, PowerPoint.
• Medical Terminology, Anatomy and Physiology, or Pathophysiology knowledge.
• Ability to develop, implement and deliver, and assess coding education plans using a variety of methods to individual providers or provider groups.
• Ability to work in environment using multiple EMR systems.
• Ability to learn and develop documentation and education skills to perform physician education.
• Ability to work collaboratively with others as well as independently.

Requirements

• Reviews medical record documentation for accurate assignment and support of diagnosis, CPT, and E&M codes.
• Monitors provider selected E&M codes on a routine and focused basis to ensure documentation supports medical necessity, code specificity, and compliance to promote the highest coding accuracy.
• Develops and delivers education material to promote clear, accurate and complete documentation and compliance with professional coding standards.
• Meets or exceeds departmental accuracy and productivity standards.
• Communicates documentation opportunities and monitoring results in a clear, constructive, and provider-friendly manner.
• Fosters teamwork and collaboration.
• Attends hospital and medical staff meetings to respond to documentation related issues.
• Partners with revenue cycle teams to resolve complex coding-related issues.
• Supports professional coders with pre-bill edits as needed.
• Facilitates change processes required to capture needed documentation on EMR templates.
• Assists in appeals process resulting from third party reviews.
• Acts as a subject matter expert for professional coding and documentation improvement questions.
• Performs all other duties as assigned.

Benefits

• Medical Plan
• Prescription drug coverage & In-House Employee Pharmacy
• Dental Plan
• Vision Plan
• Flexible Spending Account (FSA)
• - Healthcare FSA
• - Dependent Care FSA
• Retirement Savings and Investment Plan
• Basic Group Term Life and Accidental Death & Dismemberment (AD&D) Insurance
• Supplemental Group Term Life & Accidental Death & Dismemberment Insurance
• Disability Benefits – Long Term Disability (LTD)
• Disability Benefits – Short Term Disability (STD)
• Employee Assistance Program
• Commuter Transit
• Commuter Parking
• Supplemental Life Insurance
• - Voluntary Life Spouse
• - Voluntary Life Employee
• - Voluntary Life Child
• Voluntary Legal Services
• Voluntary Accident, Critical Illness and Hospital Indemnity Insurance
• Voluntary Identity Theft Insurance
• Voluntary Pet Insurance
• Paid Time-Off Program