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Profee Clinical Data Quality Admin
4 months ago
Job Summary:
Responsible for professional fee (pro-fee) coding quality and audits, education and training, etc. for CPT, ICD-10-CM, and HCPCS codes for Virtua Medical Group clinicians and coding department. This includes performing internal audits, overseeing external audits, and providing education and training to the pro-fee coders. Responsible for working with VMG practices to resolve all coding issues that prevent accounts from being processed appropriately. Responsible for developing, implementing and maintaining compliance plan for pro-fee coding and abstracting.
Position Responsibilities:
Training and Education:
Providing training and education for newly hired coders that includes utilizing the medical record in conjunction with rules and regulations to properly code VMG encounters. Audits new coders once they approved to submit charges in the work queues and provides appropriate feedback. Developing coding and training resources for the entire coding team (modules, scenarios, tip sheets, etc.). External Coding Audit Response: Conducts Trains new coders to utilize the medical record, clinical, coding and abstracting systems, in conjunction with UHDDS and other rules and regulations and other appropriate resources to properly abstract and code all HIM coded inpatient and outpatient accounts and provides appropriate feedback.exit interviews with external auditors, prepares rebuttals and appeals, take appropriate action with responses (including correcting data and educating providers and coders). Responds to daily questions from VMG coders regarding correct application of coding guidelines to individual accounts. Responsible for initial onboarding education of all clinicians billing under VMG tax ID number (TIN) to include CMS 1995, 1997 and AMA 2021 Evaluation and Management guidelines.
Auditing:
Performing chart audits to review CPT, ICD-10- CM and HCPCS codes assigned by VMG coding staff and providing timely feedback to staff and director. Overseeing the annual external audit process for all clinicians that bill under the VMG TIN by creating audit samples, communicating results to clinicians and providing annual coding education. Performing chart audits to review CPT, ICD-10- CM and HCPCS codes for clinicians who scored below 80% on their external audit. Reviewing work queue edits for provider coding trends and education needs. Confidently educates clinicians based on chart audit and coding trends.
Accounts Receivable:
Assisting with monitoring of pre-AR aging reports. Troubleshooting and resolving complex problems with individual accounts in order to facilitate appropriate reductions in A/R and accounts held for coding. Coding charts when urgently needed to facilitate A/R goals. Working closely with Practice Directors and Practice Managers to provide efficiencies in operational workflows related to clinician coding.
Review and Resolution of Interdepartmental Coding-related Issues:
Working closely with VMG Practices and third party billing company to resolve coding and reimbursement issues, serves as an escalation point, and answers questions regarding coding requirements. Providing education to their staff, including clinicians and billers on pro-fee coding issues. Recommending changes to workflows to insure appropriate documentation and reimbursement.
Policies and Procedures:
Developing policies and procedures on coding, data abstraction and compliance for VMG. Documenting and enforcing policies and procedures for VMG and provides feedback to appropriate supervisors and/or staff. Recommending changes to policies, procedures, charge master and documentation requirements to ensure appropriate reimbursement. Monitoring and reporting on productivity and quality standards.
Position Qualifications Required / Experience Required:
3 years professional fee (provider) coding experience required
Professional fee auditing and education experience preferred
Multi-specialty professional fee coding experience preferred
Knowledge of PC database applications, Microsoft Office, spreadsheet design, encoder required
Subject matter expertise in the areas of CPT, ICD-10-CM and HCPCS coding required
Ability to develop and present education presentations required
Required Education:
Coding Certificate Program, or equivalent experience, leading to appropriate certification
Training/Certifications/Licensure:
CPC Certification by AAPC required
CPMA Certification by AAPC preferred
Virtua welcomes all individuals, inclusive of race, sex, sexual orientation, gender identity, religion and faith, national origin, and disabilities, and we proudly look to each person's unique achievements and experiences to continue to set us apart. Our whole-hearted commitment to an inclusive, diverse, and equitable workplace enables Virtua to be here for our communities, here for our patients, here for our colleagues-Here for Good.
