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Endeavor Health · 3 weeks ago

Coding and Compliance Analyst Sr.

Skokie, IL

Full-time

Hybrid

Mid, Senior Level

$32.60/hr - $48.90/hr

3+ years exp

Endeavor Health is a fully integrated healthcare delivery system committed to providing quality care. The Coding and Compliance Analyst Sr. will educate healthcare providers on documentation practices, ensure compliance with coding regulations, and conduct audits to identify income-enhancing opportunities.

CommunitiesHealth CareMedicalTherapeutics

Responsibilities

Analyzes progress notes, op reports, pathology reports, encounter forms, explanation of benefits, patient insurance information, and various other health information documents for pro-fee coding and billing accuracy

Assigns appropriate ICD-10, CPT, and HCPCS codes to medical record documentation under review by applying physician specialty coding rules, third party payor guidelines, and Medicare Local Medical Review Policies

Assists Manager/Director with providing information to the physician or medical specialty based on the Office of Inspector General’s (OIG) and Centers for Medicare and Medicaid Services (CMS) risk areas. Reads the OIG's Semi-Annual reports and the OIG'S/CMS's Annual Workplan, in addition to notifications published on government websites

Performs physician and departmental documentation reviews based on industry standard coding and billing guidelines and payer policies to provide documentation and workflow improvement opportunities

Works with MG physicians or clinic personnel, HIRS, to interpret medical record documentation and/or documentation summary as necessary

Works with Customer Service and MG Operations to review and resolve escalated patient coding disputes

Works collaboratively with Billing, HIRS, overseeing provider/specialty and Denials Management Team to provide educational and/or income enhancing opportunities when issues are identified by those teams

Conducts educational sessions with Site Directors, Practice Managers, and providers on frequently seen coding errors in their site and assists with implementing changes to improve coding quality and minimize compliance risk

Provides feedback to Manager/ Director that identifies inefficient coding/operational processes

Assists with related special projects as assigned by Manager/ Director

Initiate and provide coding education to all MG billing providers, focusing on Evaluation and Management (E&M) documentation and billing requirements, as well as any specialty-specific coding guidelines

Works on special projects with the Hospital Billing Business Office and/or the Finance Department to perform reimbursement analysis functions as assigned by Manager/ Director

Submits ideas to Manager of Coding Quality & Auditing departmental newsletter based on coding/billing issues, coding help-line questions, or results of provider audits. May produce Monthly Newsletter if assigned

Participates in Coding and Business Operation Education in-services assigned by Manager

Researches multi-specialty coding and billing questions received from the Coding Help-line/email for EHMG provider/staff and provides verbal or written response as appropriate. Maintains filing system of all questions received and answers provided to caller

Identifies trends or patterns of questionable coding and billing practices at Hospital Outpatient and Medical Group sites and reports issues to Manager

Reports compliance concerns to Manager or compliance hotline according to the Endeavor Healthcare Corporate Compliance Policy/Procedures

Develops physician coding tools such as ICD-10 and CPT-4 cheat sheets, coding grids, tip sheets and other educational material for multi-specialty providers to identify appropriate codes or modifiers reimbursed by payers for services performed

Assists in the creation of progress note templates per specialty utilizing the CMS documentation regulations or CPT Assistant guidelines as requested by physician's) or assigned by supervisor

Attends multi-specialty physician coding, billing, reimbursement seminars to maintain and increase coding, billing, reimbursement expertise/ knowledge

Maintains coding credential by obtaining the requiring continuing education credits per calendar year

Qualification

ICD-10 codingCPT codingHCPCS codingCoding complianceMedical billingEpic Billing SystemsPresentation skillsHealthcare AdministrationMedical terminologyMS Office proficiencyAnalytical skills

Required

Bachelor's degree in Health Information Management, Healthcare Administration, Nursing, or related field required; equivalent years of work experience in related field will be considered in lieu of degree

RHIA, RHIT, CCS-P, CCS, or CPC required

3-5 years of related experience in physician and hospital outpatient medical billing, reimbursement, physician audits, chart review, coding compliance, medical office or patient accounts

1-2 years' experience working with Senior Physician Management a plus

The ability to work independently, with little to no supervision

Strong presentation and communication skills

The ability to interpret and analyze medical record documentation, encounter forms, and lab reports, Explanation of Benefits, CMS claim forms, third party payor guidelines and government regulations

Aptitude for medical terminology, ICD-10, CPT-4, and HCPCS coding systems

Demonstrated expertise in multi-specialty evaluation & management (E/M) coding

Knowledge of research steps utilized to identify appropriate code selection or billing requirements

Proficiency in MS Office's suite of products, including Excel and PowerPoint, and the internet

Experience with Epic Billing Systems, including chart review, transaction inquiry, etc