Description
Summary:
Reports to PFS Manager responsible for audit and education. Performs coder and provider audits of ICD-10 codes CPT codes HCPCS codes and HCC's. Prepares training materials and provides education as needed. Stays abreast of industry and payer changes pertaining to coding and documentation guidelines
Responsibilities:
Audit professional ambulatory medical records (inpatient visits outpatient visits medication administration surgeries and office/clinic procedures) to assure billed codes are accurately supported by the documentation.
Possess knowledge of teaching physician regulations including incident to split shared and attestation requirements.
Review diagnoses procedures and modifiers assigned by coders and record outcomes. Share completed audit results with Validation Team Leadership who will relay results to Coding Manager and/or Director so they can provide feedback to the individual coders as needed.
Review diagnoses and procedures assigned by providers and record outcomes. Shared completed audit results with Validation Team Leadership who will relay results to individual providers and provider leadership.
Review medical records for hierarchal condition coding (HCC's) in advance of patient visits to identify chronic conditions that the provider may want to assess.
Stay abreast of coding and documentation guidelines compliance policies annual coding updates payer policies and industry changes. Utilize this knowledge in day to day workload.
Identify coding/documentation trends that may pose a risk to Brown University Health or its revenue stream and report such trends to management team. Recommend improvements to documentation templates in Epic that will minimize compliance risk and facilitate accurate documentation for the providers. Assure documentation is defensible in the event of an external audit.
Work with Practices/Clinics Providers Coding Team Corporate Compliance Risk Management Contracting and Payers to help assure that all departments are consistently on the same page and able to provide accurate feedback to coders and providers.
Abides by the Standards of Ethical Coding as set forth by the American Academy of Professional Coders and American Health Information Management Association. Other information:
BASIC KNOWLEDGE:
Associate degree and/or successful completion of coding certification program. Understanding of the content of the medical record. Trained in medical terminology medical science anatomy and physiology. Ability to recognize and understand clinical documentation pertinent for coding. Good writing skills to communicate coding/documentation issues clearly. Computer literate; capable of researching websites to access regulatory requirements. Ability to navigate the patient electronic medical record.
Excellent written and oral communication skills. Proficient in Microsoft Word Excel and other computer applications.
EXPERIENCE:
Five years coding experience preferable in a large academic practice/facility. Past auditing experience or strong background in coding preferred.
WORKING CONDITION AND PHYSICAL REQUIREMENTS:
Normal office environment.