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Certified Professional Coding Specialist

4 weeks ago

Franklin, United States HealthFirst Family Care Center Inc. Full time

Description:
**JOB TITLE**: Certified Professional Coding Specialist

**REPORTS TO**: Director of Revenue Operations

**DEPARTMENT**: Finance

**EDUCATION/EXPERIENCE**: Holds a CPC certification. 2+ years direct experience with Medicaid and Medicare billing, preferably in an FQHC

**JOB SUMMARY**:
The Certified Professional Coding Specialist is responsible for validation, submission, and processing of all charge entry through AthenaOne. They will collaborate closely with the Director of Revenue Operations, the Practice Manager, and the Medical Director. They will constantly communicate and audit documentation to provide continuing education and training to all clinical staff on coding and documentation requirements, monitor performance, and provide feedback. This position is a key change agent in identifying opportunities for improvement within the coding and processing workflow for the revenue cycle.

**DUTIES and RESPONSIBILITIES**:

- Accounts for coding and abstracting of patient encounters, including diagnostic and procedural information, significant reportable elements, and complications.
- Reviews and verifies documentation that supports diagnoses, procedures, and treatment results.
- Analyzes medical records and identifies documentation deficiencies.
- Follows coding conventions. Identifies discrepancies, potential quality of care, and billing issues. Researches, analyzes, recommends, a plan of action to correct discrepancies and prevent future coding errors.
- Identifies reportable elements, complications, and other procedures.
- Audits clinical documentation and coded data to validate that the documentation supports services rendered for reimbursement and reporting purposes.
- Provides feedback to HealthFirst primary care and behavioral health providers as well as the Director of Revenue Operations on revenue cycle matters, including notifying supervisors when providers or other medical staff are not timely and/or not correctly documenting office visit requirements (for example, no vitals, lack of vaccine administration, etc.).
- Researches and analyzes data needs for reimbursement.
- Assigns codes for reimbursements, research and compliance with regulatory requirements utilizing guidelines.
- Ensure accurate charging, along with accurate and efficient chargemaster (Fee Schedule) maintenance, including distribution of chargemaster to specific payers and working with all departments to ensure full charge capture.
- Collaborate with colleagues to meet revenue cycle project needs and develop workflow and technological improvements within the guidelines of Healthfirst’s revenue cycle workflows, policies, and procedures.
- Assist with independent financial audits regarding patient accounts receivable, medical cash receipts, and regulatory compliance issues in healthcare billing.
- Promote exceptional customer service and maintain compliance with all HealthFirst policies and procedures.
- Participate in appropriate meetings as needed and perform other duties as assigned.

**Requirements**:
**PHYSICAL REQUIREMENTS**:

- Remain in a stationary position (Constantly)
- Move from one worksite to another (Constantly)
- Lift and carry objects up to twenty pounds (Occasionally)
- Communicate with others to exchange information (Constantly)
- Repeat motions that include the wrist, hands, and/or fingers. (Constantly)
- Analyze accuracy, neatness, and thoroughness of the work assigned. (Constantly)
- Work in a noisy environment. (Occasionally)

**ORGANIZATIONAL EXPECTATIONS**:

- Support the Mission of HealthFirst
- Interact with persons of various social, cultural, economic, and educational backgrounds in a respectful and dignified manner.
- Establish and maintain cooperative working relationships with co-workers and the public.
- Promote a positive work environment.
- Perform job duties and responsibilities in a manner that reflects the highest ethical and professional standards of conduct and performance.
- Present a professional, business-like image to patients, visitors, and the public.
- Treat confidential information (including Protected Health Information) with respect and care, whether oral, written, or electronic in a manner that ensures its confidentiality.
- Work in a safe and responsible manner.

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