Medical Coding Compliance Educator

Hourly Pay Range:
$32.60 - $48.90 - The hourly pay rate offered is determined by a candidate's expertise and years of experience, among other factors.
Position: Senior Coding Educator
Full Time
Hours: Monday-Friday, 8:00am-4:30pm A Brief Overview:
The purpose of this job is to educate physicians, other qualified billing providers, and ancillary staff on their documentation for all specialties and review providers progress notes, as needed, to ensure coding/billing compliance in accordance with coding rules, third party payor guidelines, governmental regulations, and MG's Coding Compliance Program. The Senior Analyst, as a coding and billing expert, will assist all freestanding and provider-based outpatient departments with ICD-10, CPT-4, and HCPCS coding education and billing regulation interpretation. 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 MG physicians or clinic personnel, HIRS, to interpret medical record documentation and/or documentation summary as necessary.
Works with Customer Service and MG Operations to review and resolve escalated patient coding disputes.
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.
Assists with related special projects as assigned by Manager/ Director.
Initiate and provide coding education to all MG 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. 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 EHMG provider/staff and provides verbal or written response as appropriate. 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 Endeavor Healthcare 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. Bachelor's degree in Health Information Management, Healthcare Administration, Nursing, or related field required; equivalent years of work experience in related field will be considered in lieu of degree
Experience: 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 Other required skills * The ability to work independently, with little to no supervision
The ability to interpret and analyze medical record documentation, encounter forms, and lab reports, Explanation of Benefits, CMS claim forms, third party payor guidelines and government regulations.
Aptitude for medical terminology, ICD-10, CPT-4, and HCPCS coding systems.
Proficiency in MS Office's suite of products, including Excel and PowerPoint, and the internet.
Experience with Epic Billing Systems, including chart review, transaction inquiry, etc. Various Medical, Dental, and Vision options
Tuition Reimbursement
Health Savings Account Options
Retirement Options with Company Match
Paid Time Off and Holiday Pay
Community Involvement Opportunities Endeavor Health is a fully integrated healthcare delivery system committed to providing access to quality, vibrant, community-connected care, serving an area of more than 4.2 million residents across six northeast Illinois counties. Our more than 25,000 team members and more than 6,000 physicians aim to deliver transformative patient experiences and expert care close to home across more than 300 ambulatory locations and eight acute care hospitals - Edward (Naperville), Elmhurst, Evanston, Glenbrook (Glenview), Highland Park, Northwest Community (Arlington Heights) Skokie and Swedish (Chicago) - all recognized as Magnet hospitals for nursing excellence. Located in Naperville, Linden Oaks Behavioral Health, provides for the mental health needs of area residents.