Coding and Compliance Education Lead

Candidates must live in Ohio. Position is eligible for remote/onsite hybrid work arrangement after completion of 90-day introductory period.

Position Summary: Responsible for educating and training Orthopedic One's Coding Staff and Providers as directed by the Patient Accounts Director. Will oversee or perform the overall auditing and education plans for the coding staff, providers and patient accounts team.

Responsibilities/Accountabilities:

Coding Audits and Education:

Perform coding quality audits, provide ongoing feedback and education.

Researches and coordinates workflows and efficiencies for coding denials from Payers.

Works collaboratively with Patient Accounts Leadership and Clinic Operations to ensure communication with Patient Accounts Department is clear, complete and timely

Reviews hospital and clinic notes and conducts coding reviews; reviews documentation and coding for all services including but not limited to E&M level of service, surgical procedures, modifier usage diagnosis code supporting medical necessity, injections, DME, and radiology.

Researches, analyzes, and responds to inquiries regarding inappropriate coding, denials, and billable services in accordance with all CMS/Federal and state guidelines.

Builds revenue cycle edits and work flows on EMR to improve effectiveness.

Coordinates with Accounts Receivable:

Works as a lead, assisting with overseeing daily operations of coding team to ensure adequate distribution of workloads and assignments.

Monitors productivity and KPI's to ensure revenue cycle benchmarks are met.

Reviewing all reimbursement tools for coding/policy additions, revisions and deletions. Items must be communicated in a timely manner to all pertinent providers and staff.

Track and trends on missed opportunities that lead to denied claims.

Identifies specific aberrances and atypical billing. Identify potential risk to the organization and ensure compliance to policies.

Develops educational materials to conduct classroom and/or Individual training/education to all providers and staff on coding, documentation, and CMS/Federal guidelines.

Creates and implements annual all staff education for CPT code changes, ICD-10 and HCPCS.

Performs reimbursement analysis for new procedures, unlisted codes and new technology to ensure proper coding and billing documentation is met.

Maintains and processes all Government Payer Audits and provides continuous education regarding CMS LCD/NCD's and government policies.

Supports Leadership to Train Staff:

Orients new staff and new providers, ensuring they know the purpose of the organization, their department and position.

Supports leadership in providing associates with resources, tools, feedback, assistance and training needed to achieve desired performance including productivity and qualitative expectations.

Provides effective and timely on-the-job training as assigned such that performance objectives are clear, staff members have knowledge and skills necessary to perform effectively.

Educates staff on all applicable new or established policies, procedures, and expectations.

Customer Service and Communications:

Communicates with patients, insurance carriers and other outside entities in a professional manner. Identifies solutions and responds professionally to patient concerns, i.e., pleasant tone of voice, courteous language, etc. Uses appropriate grammar and demonstrates tact and diplomacy in patient interactions, by phone and in person.

Diffuses negative situations with patients and maintains a pleasant and professional tone during stressful circumstances and heavy workload.

Communicates with staff members in a professional, pleasant manner; Shares information relevant to work, no gossiping or disparaging remarks, accepts work without complaint or provides reasons why assignment is unmanageable, asks and answers questions related to improving department performance.

Professional Development:

Prepares appropriately to attend and participate in company meetings or projects as assigned.

Facilitates special projects or assignments at the request of management.

Attends to own professional development responsibilities and encourages/plans for staff to do the same.

Teamwork:

Works cooperatively with coworkers, providers, and management.

Shares knowledge and insights with co-workers in a constructive manner.

Willingly provides coverage to department, staying beyond scheduled ending time when clinic schedule demands it, volunteering to cover time off or unexpected absences, maintaining workflow in department without direct supervision.

Addresses conflicts with person directly before involving manager or uninvolved peers.

Is considerate of others with regard to taking breaks or meal periods, use of computer and telephone, and noise in department.

Policies and Procedures:

Knows and complies with policies and procedures as enumerated in the Orthopedic One Employee Handbook and policies and procedures documents.

Provides assistance and support to leadership in implementing policies and procedures as necessary.

Actively participates in training, and conducting day to day work activity by adhering to all policies and procedures as enumerated in compliance and risk management programs.

Education, Experience, and Certification/Licensure Required: Position requires an Associate's degree in health information management or a certificate in medical coding. The applicant must have a minimum of 3-5 years of experience working in healthcare reimbursement Professional and Surgical coding/auditing experience. Previous experience with Microsoft Office Suite, and EMR/Practice Management Experience. RHIT, RHIA, CPMA, CPC, CCS or CCS-P. Must maintain the required CEU's and credentials. Must be proficient in ICD-10 CM and CMS guidelines.