Under the direction of the Physician Coding Manager, and following a pre-determined or assigned audit schedule, provide an evidence-based review of select primary and specialty care E&M and procedural charges to ensure correct coding, legal compliance and complete charge capture. This person may also be asked to assist with other special projects related to charge capture and rebilling projects. Participation in the department's performance improvement and continuous quality improvement activities is required.

EXEMPT

Using CPT and ICD-9/ICD.10, HCPCs II, provider documentation and other approved resources, evaluate the proper assignment of procedure, modifier and diagnosis codes to professional services in order to validate accuracy and compliance.

Collate, transfer and analyze all auditing results to capture and illustrate risk issues, revenue leakage and educational opportunities.

Provide physician feedback, initial and ongoing education and training, and technical support in regards to proper clinical documentation guidelines, service selection, charge capture and timely submission, healthcare data accuracy and coding principles.

Assist with developing and implementing recommendations for changes in policies and procedures relevant to correct and complaint coding.

Serve as a resource for physicians, billing and coding staff and administrative staff relative to technical guidance on professional coding issues.

Stay current with all coding changes and updates through regular research and verification.

Responsible for identifying issues and implementing process improvements for charge accuracy.

Treats others with respect; maintains confidentiality

Demonstrates a good working relationship within the department and with other departments

Demonstrates the ability to be flexible and organized in stressful situations.

Operates equipment safely and correctly.

Perform other projects as assigned by Manager of Physician Coding.

Demonstrates the ability to deal with pressure to meet deadlines, to be accurate, and to handle constantly changing situations.

Demonstrates the ability to deal with a variety of people, deal with stressful situations, and handle conflict.

Professional Requirements:

Adheres to dress code.

Completes annual educational requirements.

Maintains regulatory requirements.

Wears identification while on duty.

Maintains confidentiality at all times.

Attends department staff meetings as required within the department.

Reports to work on time and as scheduled; completes work in designated time.

Represents the organization in a positive and professional manner.

Actively participates in performance improvement and continuous quality improvement (CQI) activities.

Coordinates efforts in meeting regulatory compliance, federal, state and local regulations and standards

Communicates and complies with the Benefis Health System Mission, Vision and Values as well as the focus statement of the department.

Complies with Benefis Health System Organization Policies and Procedures.

Complies with Health and Safety Standards and Guidelines.