Professional Coding Education Specialist

EvergreenHealth; Kirkland (WA); Hybrid; USD 94,363,000 - 150,949,000; Full time

Benefits offered by this job

Medical, vision and dental insurance

Paid time off

Tuition assistance

Retirement plans

Commuter benefits

Job summary

EvergreenHealth is seeking a dedicated coding auditor to independently perform coding reviews and audits, assess documentation opportunities, and mitigate risk. You will provide timely reports to providers and leadership, and act as a subject matter expert in professional coding, including CPT, ICD-10-CM, and HCPCS.

Role requires developing and presenting education on documentation guidelines, payer reimbursement rules, and coding training for physicians, APPs, and production coders.

Qualifications

• Independent coding reviews and audits to assess accuracy and risk.
• Provide detailed audit reports to providers and leaders.
• Develop education for professional coding and documentation guidelines.
• Create training for physicians, APPs and coders based on audit findings.
• Travel to clinic locations to educate staff on coding and documentation.

Responsibilities

• Independently performs highly complex coding reviews to assess accuracy and mitigate risk.
• Completes documentation audits and provides detailed audit reports to providers and leaders.
• Acts as SME in professional coding (CPT, ICD-10-CM, HCPCS) and guides staff.
• Develops customized education on professional coding and reimbursement rules.
• Creates and presents coding training for new physicians and coders.
• Travels to clinics to educate physicians and staff on coding practices.
• Provides classroom/individual education to clinic managers and staff.
• Advises billing office on coding compliance concerns.
• Develops coding guides and updates for regulatory changes.
• Identifies areas for process improvement to meet policies.

Skills

Coding audits

Documentation improvement

Medical terminology

Communication skills

Payer billing requirements

Regulatory knowledge

HIPAA/compliance

Education

High school diploma or G.E.D

AAPC/PMI/AHIMA coding credentials

Job description

Wage Range: $32.92 - $52.68 per hour

Hybrid remote in the state of Washington only

Posted wage ranges represent the entire range from minimum to maximum. For jobs with more than one level, the posted range reflects the minimum of the lowest level and the maximum of the highest level. Some positions also offer additional premiums based on shift, certifications or degrees. Job offers are determined based on a candidate's years of relevant experience, level of education and internal equity.

Job Summary

Responsible for independently performing coding reviews and audits to assess coding accuracy, documentation improvement opportunities, and mitigate organizational risk. Provides detailed and timely audit reports to providers and leaders. Acts as subject matter expert in professional coding including CPT, ICD-10-CM, and HCPCS. Develops and presents customized education for professional coding, documentation guidelines, payer reimbursement rules and regulations. Creates and presents customized coding training for new physicians, advanced practice providers and production coders. Travels to clinic locations to build and maintain relationships with physicians, advanced care providers and other clinical staff as needed. Provides classroom and/or individual education as requested. Advises the professional billing office regarding billing compliance concerns and recommends appropriate guidance. Develops written coding guides, training documents, and updates. Identifies and investigates potential compliance risks related to coding in collaboration with the Professional Coding Manager and Compliance Officer.

Primary Duties

1. Independently performs highly complex and detailed coding reviews and audits to assess coding accuracy, documentation improvement opportunities, and mitigate risk.
2. Completes documentation audits and provides detailed and timely audit reports to providers and leaders.
3. Acts as subject matter expert in professional coding including to provide feedback and accurate guidance to physicians, advanced practice providers, professional billing staff, clinic staff, and clinic leaders.
4. Develops and presents customized education for professional coding, documentation guidelines, payer reimbursement rules and regulations for physicians and advanced practice providers based on documentation audit findings.
5. Creates and effectively presents customized coding training for new physicians, advanced practice providers and production coders.
6. Periodically travels to clinic locations to build and maintain relationships with physicians, advanced care providers and other clinic staff and provide coding and documentation education as needed.
7. Provides classroom and/or individual education to clinic managers, support staff, production coders, professional billing staff and others as requested.
8. Advises the professional billing office regarding coding compliance concerns and recommends appropriate guidance.
9. Develops written coding guides, training documents, and updates regarding coding and regulatory changes for physicians, advanced practice providers, coding staff, clinic staff and the professional billing department.
10. Suggests potential areas for improvement to meet organizational policies and procedures.
11. Identifies and investigates potential compliance risks in collaboration with the Professional Coding Manger and Compliance Officer.

License, Certification, Education or Experience

REQUIRED for the position:

• High school diploma or G.E.D
• Current professional coding credential: AAPC (Certified Professional Coder [CPC], Certified Outpatient Coder [COC]), PMI (Certified Medical Coder [CMC]), or AHIMA (Certified Coding Specialist-Physician [CCS-P], Certified Coding Associate [CCA], Certified Coding Specialist [CCS], Registered Health Information Administrator [RHIA], Registered Health Information Technician [RHIT])
• One year of professional coding experience in a multi-specialty medical group setting.
• Extensive knowledge in ICD-10, CPT and HCPCS coding for professional services.
• Proficient knowledge of medical terminology and coding and sequencing guidelines.
• Comprehensive understanding of anatomy, physiology and disease processes.
• Expanded understanding of payer billing requirements.
• Excellent written and verbal communication skills

DESIRED for the position:

• Five years coding experience and/or one to three years performing documentation audits in a multi-specialty medical group setting.
• AAPC specialty surgical certification(s): Certified Professional Medical Auditor [CPMA], Certified Evaluation & Management Coder [CEMC], Certified Cardiology Coder [CCC], Certified Cardiovascular and Thoracic Surgery Coder [CCVTC], Certified Gastroenterology Coder [CGIC], Certified General Surgery Coder [CGSC], Certified Interventional Radiology Cardiovascular Coder [CIRCC], Certified Obstetrics Gynecology Coder [COBGC], Certified Ophthalmology Coder [COPC], Certified Orthopedic Surgery Coder [COSC], Certified Urology Coder [CUC]).

Benefit Information

Choices that care for you and your family

At EvergreenHealth, we appreciate our employees’ commitment and contribution to our success. We are proud to offer a suite of quality benefits and resources that are comprehensive, flexible, and competitive to help our staff and their loved ones maintain and improve health and financial well-being.

• Medical, vision and dental insurance
• On-demand virtual health care
• Health Savings Account
• Flexible Spending Account
• Life and disability insurance
• Retirement plans (457(b) and 401(a) with employer contribution)
• Tuition assistance for undergraduate and graduate degrees
• Federal Public Service Loan Forgiveness program
• Paid Time Off/Vacation
• Extended Illness Bank/Sick Leave
• Paid holidays
• Voluntary hospital indemnity insurance
• Voluntary identity theft protection
• Voluntary legal insurance
• Pay in lieu of benefits premium program
• Free parking
• Commuter benefits