Profee Clinical Data Quality Admin

3 weeks ago

Marlton, United States VIRTUA Full time

Must live in a commutable distance to Marlton, NJ

**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**:
**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

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

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