Coding Education and Quality Specialist

HealthPartners; Minneapolis (MN); On-site; USD 70,000 - 95,000; Full time

Job summary

Park Nicollet is seeking a Coding Education and Quality Specialist to partner across HealthPartners and clinical departments, ensuring accurate coding and revenue capture. You will support CPT, HCPCS, and ICD-10 CM coding with payor policy guidelines and EMR tools, collaborating with clinicians and coders to improve documentation and coding quality.

The ideal candidate brings formal coding education or a health information degree, RHIT/RHIA or coding certificates, and strong MS Office and data

Qualifications

• Coding knowledge of CPT/HCPCS/ICD-10 CM, anatomy, physiology and medical terminology
• Proficient in Excel reporting and pivot tables
• Ability to research, analyze data and identify revenue opportunities
• Strong independent work, time management and decision-making skills

Responsibilities

• Ensure services are documented and billed accurately in the medical record
• Review coding practices and summarize revenue opportunities
• Understand EMR charting tools, templates, order entry and charge capture
• Identify revenue opportunities from data, reports and clinician documentation
• Provide education and feedback to coders, clinicians and clinics to reduce denials
• Attend department meetings and help revise coding policies and education materials
• Create onboarding educational materials for new clinicians
• Monitor coding denials and support third party payors to capture revenue

Skills

CPT coding

HCPCS coding

ICD-10 CM coding

Microsoft Office

Education

Health information degree or coding education program

Tools

Epic

Job description

Park Nicollet is hiring a Coding Education and Quality Specialist. The Coding Education and Quality Specialist is a highly visible position that is responsible for partnering system wide with Clinicians and clinic operations staff to support the HealthPartners Revenue Cycle. This role is responsible for understanding revenue cycle workflow, identifying opportunities to ensure all appropriate revenue is captured, and assist in closing documentation gaps for clinical departments supported by the professional coding team.

Must have an in-depth understanding of coding and compliance rules and regulations and knowledge of the Electronic Health Record (EHR). Will provide system wide support to Clinicians, clinical departments, and coders for CPT, HCPCS, ICD-10 CM coding systems and payor policy guidelines.

MINIMUM QUALIFICATIONS:

• Education, Experience or Equivalent Combination:
  • Must have completed a coding education program or must be a graduate from an associate or bachelor's degree program in health information.
• Licensure/ Registration/ Certification:
  • Must have one of the following RHIT (registered health information technician), RHIA (registered health information administrator), or coding certificate. Coding certificates can include: CCA (certified coding associate), COC (certified outpatient coder), CCS (certified coding specialist), CPC (certified professional coder), CCS-P (certified coding specialist-physician).
• Knowledge, Skills, and Abilities:
  • Knowledge in using CPT, HCPCS, ICD-10 CM coding guidelines, rules and regulations, anatomy, physiology, basic disease processes and medical terminology
  • Intermediate knowledge of Microsoft Office Suite. Ability to create excel spreadsheets and pivot tables for reporting and data analysis.
  • Must be able to work independently, apply time management and critical thinking skills, and have strong decision-making skills.
  • Must be a highly skilled and experienced coder who can independently research, analyze and understand large amounts of data, identify issues that have financial impact and provide opportunities to improve coding quality.
  • Ability to present information in one-on-one and/or group settings and communicate information in a professional and confident manner.
  • Must have a thorough understanding of revenue cycle stream.

PREFERRED QUALIFICATIONS:

• Education, Experience or Equivalent Combination:
  • Three years coding experience
  • Epic experience preferred
  • Experience working with online coding resources and other related software programs.
  • Strong E & M coding experience
• Licensure/ Registration/ Certification:
  • N/A
• Knowledge, Skills, and Abilities:
  • Ability to present and communicate information in either individual and/or group settings in a professional and confident manner.

ESSENTIAL DUTIES:

1. (75%) - Ensures all services provided are accurately documented in the medical record and billed appropriately. This is accomplished using the following methods:
   1. One-on-one chart review with clinician and/or departments as needed. Provide feedback based on identified coding trends.
   2. Review coding practices for clinical departments and prepare summaries of revenue opportunities based on a detailed analysis.
   3. In-depth understanding of EMR in the areas of charting tools such as templates, order entry, smart sets, and overall charge capture process flow.
   4. Identify revenue opportunities through various methods such as the review of data, charge reconciliation reports and clinician documentation.
   5. Proposes front end charge improvements as needed and provide education & feedback to coders, clinicians and clinic departments for denials that impact revenue flow and or capture.
   6. Attends clinic department meetings to communicate and distribute coding and documentation information. Partners with clinic departments regarding clinical documentation improvements and/or other educational opportunities.
   7. Partners with clinicians and coding teams for customer service issues.
   8. Create and provide educational material to new onboarding clinicians. Ex: New Clinician Orientation recorded videos, tip sheets, virtual Q&A, etc.
2. (5%) - Independently performs root cause analysis and oversee volume and dollars for coding denials working directly with third party payors to understand policies and capture appropriate revenues. May provide direction and assistance to the coding teams working denied charges.
3. (5%) - Provides coding education (HCPCS, ICD-10 CM, DSM5, & CPT) to coders, clinicians, and clinic departments. Works with Compliance Operations to support the annual monitoring work plan. Partners with Diagnosis Accuracy Team to support risk adjustment requirements, diagnosis accuracy tools and collaborate with HealthPartners Health Plan to optimize diagnosis coding.
4. (5%) - Performs coding quality reviews for coding staff and provides education/feedback in partnership with coding leaders. Leverage EMR technology to create revenue capture solutions or make suggestions on operational changes.
5. (5%) - Attends coding related meetings (Ex: Coding Support Committee), and other department meetings when required and participates in creating/revising coding policies, procedures and/or education materials. Become familiar with clinic department operational processes or practices, and partner on improvement opportunities.
6. (5%) - Performs other duties as assigned.

*Job description rankings/percentages are intended to reflect normal averages over an extended period of time, and are subject to daily variances. Quality and efficiency standards should at no time be compromised to meet the average expectations expressed above. Job descriptions are subject to change to accommodate organization or department needs.