You are applying for a position through Medix, a staffing agency. The actual posting represents a position at one of our clients.
Company Information
Our client company
Job Summary
Our client is seeking a skilled Coding Educator. In this role, you will be responsible for educating physicians, qualified billing providers, and ancillary staff on documentation practices across all specialties. Your primary goal will be to review provider progress notes to ensure coding and billing compliance with coding rules, third-party payor guidelines, governmental regulations, and internal coding compliance programs. You will also conduct face-to-face summary review sessions, report findings, and identify income-enhancing opportunities.
Key Responsibilities
- Analyzes progress notes, op reports, pathology reports, encounter forms, explanation of benefits, patient insurance information, and various other health information documents for pro-fee coding and billing accuracy.
- Assigns appropriate ICD-10, CPT, and HCPCS codes to medical record documentation under review by applying physician specialty coding rules, third party payor guidelines, and Medicare Local Medical Review Policies.
- Assists Manager/Director with providing information to the physician or medical specialty based on the Office of Inspector General’s (OIG) and Centers for Medicare and Medicaid Services (CMS) risk areas. Reads the OIG's Semi-Annual reports and the OIG'S/CMS's Annual Workplan, in addition to notifications published on government websites.
- Performs physician and departmental documentation reviews based on industry standard coding and billing guidelines and payer policies to provide documentation and workflow improvement opportunities.
- Works with physicians or clinic personnel, HIRS, to interpret medical record documentation and/or documentation summary as necessary.
- Works with Customer Service and Operations to review and resolve escalated patient coding disputes.
- Works collaboratively with Billing, HIRS, overseeing provider/specialty and Denials Management Team to provide educational and/or income enhancing opportunities when issues are identified by those teams.
- Conducts educational sessions with Site Directors, Practice Managers, and providers on frequently seen coding errors in their site and assists with implementing changes to improve coding quality and minimize compliance risk.
- Provides feedback to Manager/ Director that identifies inefficient coding/operational processes.
- Assists with related special projects as assigned by Manager/ Director.
- Initiate and provide coding education to all billing providers, focusing on Evaluation and Management (E&M) documentation and billing requirements, as well as any specialty-specific coding guidelines.
- Works on special projects with the Hospital Billing Business Office and/or the Finance Department to perform reimbursement analysis functions as assigned by Manager/ Director.
- Submits ideas to Manager of Coding Quality & Auditing departmental newsletter based on coding/billing issues, coding help-line questions, or results of provider audits. May produce Monthly Newsletter if assigned.
- Participates in Coding and Business Operation Education in-services assigned by Manager
- Researches multi-specialty coding and billing questions received from the Coding Help-line/email for provider/staff and provides verbal or written response as appropriate. Maintains filing system of all questions received and answers provided to caller.
- Identifies trends or patterns of questionable coding and billing practices at Hospital Outpatient and Medical Group sites and reports issues to Manager.
- Reports compliance concerns to Manager or compliance hotline according to the Corporate Compliance Policy/Procedures.
- Develops physician coding tools such as ICD-10 and CPT-4 cheat sheets, coding grids, tip sheets and other educational material for multi-specialty providers to identify appropriate codes or modifiers reimbursed by payers for services performed.
- Assists in the creation of progress note templates per specialty utilizing the CMS documentation regulations or CPT Assistant guidelines as requested by physician(s) or assigned by supervisor.
- Attends multi-specialty physician coding, billing, reimbursement seminars to maintain and increase coding, billing, reimbursement expertise/ knowledge.
- Maintains coding credential by obtaining the requiring continuing education credits per calendar year.
Qualifications
- 3-5 years of related experience in physician and hospital outpatient medical billing, reimbursement, physician audits, chart review, coding compliance, medical office or patient accounts.
- 1-2 years’ experience working with Senior Physician Management (a plus).
- Experience working within a health system (strongly preferred).
Skills
Education
- Certification: RHIA, RHIT, CCS-P, CCS, or CPC
Additional Requirements
- This is a remote opportunity, but candidates must reside within IL, IN, or WI.
- Expected to come into the office occasionally for provider education.
- Work schedule: Monday-Friday, 8:00 AM - 5:00 PM with flexibility.
Benefits
- Paid Sick Leave (Medix provides paid sick leave according to state and local sick leave ordinances).
- Health Benefits / Dental / Vision (Medix offers 6 different health plans: 3 Major Medical Plans, 2 Fixed Indemnity Plans (Standard and Preferred), and 1 Minimum Essential Coverage (MEC) Plan. Eligibility for health benefits is based on verifying that an average of 30 hours per week during the first 4 weeks of the work assignment has been met. If you meet eligibility requirements and take action to enroll, you will be covered no earlier than 60 days into your assignment, depending on plan selection(s)).
- 401k (Eligible on the first 401k open enrollment date following 6 consecutive months on assignment. 401k Open Enrollment dates are 1/1, 4/1, 7/1, and 10/1).
- Short Term Disability Insurance.
- Term Life Insurance Plan.
Required Employment / Compliance Language
Medix is an equal opportunity employer and does not discriminate in any phase of employment on the basis of race, color, creed, religion, sex, national origin, gender identity or expression, mental or physical disability, medical condition, sexual orientation, age, marital status, military status, ancestry, familial status, genetic information, or any other status protected by applicable law.
*We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state, and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO), and the California Fair Chance Act (CFCA).
Medix Overview:
With over 20 years of experience connecting organizations with highly qualified professionals, Medix is a leading provider of workforce solutions for clients and candidates across the healthcare, scientific, technology, and government industries. Through our core purpose of positively impacting lives, we’re dedicated to creating opportunities for job seekers at some of the nation's top companies. As an award-winning career partner, Medix is committed to helping talent find fulfilling and meaningful work because our mission is to help you achieve yours.
Any required state or Joint Commission training is compensated at the state or local minimum wage rate.
*As a job position within our Revenue Cycle division, a successful completion of a background check may be required as a condition of employment. This requirement is directly related to essential job functions including but not limited to: accessing financial and confidential information, handling financial and other payment data, and working within departments that care for vulnerable populations, such as, minors, elderly and those with physical or mental disabilities. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.
