Provider Coding Auditor, Educator

Responsibilities

• Supports codes from final surgical/procedural operative reports signed by the provider.
• Reviews the complex (problematic coding that needs research and reference checking) medical records, ensures documentation is supported.
• Works with Mod Med to ensure that the correct plans are used, modifiers attached and diagnosis attached.
• Audits provider medical records and charges for compliance with coding and documentation standards to ensure compliance with internal and government regulations.
• Provides continuing review and education of physician and ACPs to ensure appropriate level of care is reported.
• Partner with practices to review findings of the periodic chart review.
• Maintains a thorough understanding of anatomy and physiology, medical terminology, disease processes and surgical techniques through participation in continuing education programs to effectively apply ICD-10-CM and CPT coding guidelines to diagnoses and procedures in offices.
• Correlates information supporting clinical documentation not limited to Pathology, Radiology and/or other Physician Consultations after review by the Attending Physician, wherever appropriate.
• Regularly meets with physicians and ACPs to provide continuous education on billable services, medical record documentation, the correct use of CPT and ICD-10 codes, missed billing opportunities and erroneously reported services to minimize errors and loss of revenue.
• Interacts with and provides trends to management, revenue managers and others about coding related issues.
• Solves any coding related problems and/or answers questions regarding coding issues from the provider, office staff and billing specialists.
• Collaborates with billing specialists and appeal and edit coders to expedient resolution of accounts.
• Works together with billing specialists to develop plans to improve charge capture and billing/coding processes.
• Stays current with CPT and ICD-10-CM coding guidelines and updates.
• Communicate changes and/or updates to key stakeholders including physicians, ACPs, practice managers and leadership.
• Reports any potential compliance issues to the Director of RCM.

Requirements

• Extensive knowledge of E&M coding surgical procedures, applicable modifiers.
• Understands and apply appropriate Center Medicare Services guidelines to coding.
• Advanced ICD-10-CM & CPT‑4 coding conventions.
• Knowledge of Anatomy & Physiology and Medical Terminology.
• Ability to become a Mod Med expert to help providers utilize the system to improve documentation and how EMA is coding.
• Effective written and verbal communication skills.
• Comfortable to present to large groups of providers on coding topics and answer questions in real time.
• Ability to work independently and use time effectively to complete audits and deliver the results to each provider in a time fashion with a written report with suggestions on improvements in their documentation and coding accuracy.
• Have a solid knowledge of what is on the Inspector General watch list for coding and compliance as well as various payers medical necessity to ensure that providers individually and the organization are set up to minimize any audit risks.
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