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Tufts Medicine · 1 week ago

Professional Coding Auditor and Educator - Remote

United States

Full-time

Remote

Mid Level

$24.65/hr - $30.82/hr

4+ years exp

Tufts Medicine is a healthcare organization seeking a Professional Coding Auditor and Educator. This role focuses on revenue cycle operations, ensuring the accuracy of coding and documentation, and providing education to physicians regarding coding standards and compliance.

Health CareHospitalMedical

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 Epic to create a supportive work flow, including creation of templates, smart phrases, billing buttons, etc

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 inpatient and outpatient diagnoses and procedures

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

Qualification

Certified Professional Coder (CPC)ICD-10-CM codingCPT codingAnatomy & Physiology knowledgeMedical TerminologyCoding software familiarityData entry accuracyEffective communication skills

Required

Associates degree in medical record technology

Completion of Certified Medical Coding Program or two years of professional coding certification with courses in Medical Terminology, Anatomy & Physiology and/or extensive training in physician coding

One of the following Certifications: Certified Professional Coder (CPC), Certified Coding Specialist (CCS), Registered Health Information Administrator (RHIA) or Registered Health Information Technician (RHIT)

Four (4) years of coding experience, with at least two (2) years in surgical abstraction (physician or medical group in multi-specialty surgical practices, i.e., OBGYN, HEM/ONC, Cardiothoracic Surgery, Neurosurgery, General Surgery, Orthopedics, etc.)

Extensive knowledge of coding surgical procedures, applicable modifiers in multi-specialty setting

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

Extensive OPPS/APC/ACO reimbursement knowledge

Coding software familiarity

Effective written and verbal communication skills

Ability to perform error-free Data entry/CRT

Code and abstract from Surgical Operative Notes while providing the primary communication w/ specialty surgical providers in the health system