Medical Coder & Clinical Documentation Specialist
SUMMARY: The Medical Coder and Clinical Documentation Specialist collect and analyze data from multiple sources to ensure regulatory compliance. The incumbent independently reviews medical documentation to ensure documentation integrity and reviews claims for coding accuracy. The incumbent facilitates improvement in the overall quality of the medical record, and accuracy in medical coding. Ensures compliance with Medicare, 3rd party payer, and State and Federal regulations. The incumbent will assist in providing coding and compliance training to newly hired providers within the domain of Podiatry and Mental Health. ESSENTIAL DUTIES AND RESPONSIBILITIES: include the following. Other duties may be assigned. The items listed should be a representation of the major aspects of the job. 1. Provides coding and compliance expertise in support of claims resolution. Analyzes claims for coding accuracy. Updates information per accepted coverage guidelines and mandated state and federal regulations. 2. Provides oversight and expertise in the support of the appeals process. Conducts a comprehensive analytic review of clinical documentation to determine if an appeal is warranted. Assists in preparing appeal summaries and correspondence. Documents information for tracking/trending. 3. Through claims analysis and documentation reviews, compiles trending reports and identifies opportunities for documentation improvement and billing accuracy. 4. Educates members of the patient care team regarding documentation and billing guidelines. 5. Collaborates specifically with the Mental Health and Podiatry teams, analyzes patient medical records and creates training material. Actively participates in team meetings. 6. Assists in the training of new providers for the Mental Health and Podiatry teams by performing weekly documentation reviews during the providers first four weeks of patient care, creates informational reports that identify the providers strengths and areas of opportunities. 7. Ensures continuous quality of coding and maintains current understanding of coding developments, changes and regulations set forth by the American Medical Association (AMA) and the Centers for Medicare and Medicaid Services (CMS) 8. Safeguards the confidentiality of financial and medical records in compliance with Health Insurance Portability and Accountability Act (HIPAA) 9. Attend staff meetings as appropriate 10. Develop effective working relationships with Medical Center operations, CBO and Corporate Compliance. 11. Complete other duties as assigned. KNOWLEDGE, SKILLS AND ABILITIES: To perform this job successfully, an individual must be able to perform each essential duty at an advanced level. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. 1. Strong written and verbal communication skills 2. Possess Critical Thinking skills 3. Competent in MS Office 4. Proven/demonstrated knowledge in the following: * ICD-10-CM/CPT/HCPCS Coding * Regulatory Compliance * HIPAA and Legal Aspects of Health Information * Medical Reimbursement Methodologies * Clinical Documentation Requirements * Medical Terminology * EMR Operation * Policy/Procedure Development EDUCATION and/or EXPERIENCE: * Certified Coding Professional-Physician (CCS-P) or Certified Professional Coder (CPC) certification is required. * Completion of a CAHIIM accredited program of study for Health Information Management is preferred. * Minimum 3 - 5 years' experience with Medicare, Medicaid, Railroad Retirement and other commercial third party payer coding and billing regulations and guidelines. SUPERVISORY RESPONSIBILITIES: N/A LANGUAGE SKILLS: Must be able to read, write, understand and communicate effectively in the English language. LICENSES, CERTIFICATES, REGISTRATIONS: (Possession of AHIMA (American Health Information Management Association) CCS-P or AAPC (American Academy of Professional Coders) CPC is required.