About the Role
The Director of Coding will evaluate medical progress notes in eCW to ensure completeness, accuracy, and compliance with the International Classification of Diseases Manual - Clinical Modification (ICD-10-CM), and the American Medical Association’s Current Procedural Terminology Manual (CPT), CPT II coding and ensure providers have coded to the highest level of specificity. The Coder will also provide technical guidance and training on medical coding to physicians and staff.
Duties/Responsibilities:
Evaluates medical record documentation and coding to optimize reimbursement by ensuring that diagnostic and procedural codes and other documentation accurately reflects and supports outpatient visits and to ensure that data complies with legal standards and guidelines.
Interprets medical information such as diseases or symptoms and diagnostic descriptions and procedures to accurately assign and sequence the correct ICD-10-CM, HCC and CPT codes.
Review state and federal Medicare reimbursement claims for completeness and accuracy before submission to minimize claim denial.
Evaluates records and prepares reports on such topics as the number of denied claims or documentation or coding issues for review by management and/or professional evaluation committees.
Makes recommendations for changes in policies and procedures; works with data processing staff to revise the computer master file. Develops and updates procedures manuals to maintain standards for correct coding, to minimize the risk of fraud and abuse, and to optimize revenue recovery.
Provides technical guidance to physicians and other staff in identifying and resolving issues or errors such as incomplete or missing records and documentation, ambiguous or nonspecific documentation, and/or codes that do not conform to approved coding principles/guidelines.
Reads bulletins, newsletters, and periodicals and attends workshops to stay abreast of issues, trends, and changes in laws and regulations governing medical record coding and documentation.
Educates and advises staff on proper code selection, documentation, procedures, and requirements.
Identifies training needs, prepares training materials, and conducts training for physicians and support staff to improve skills in the collection and coding of quality health data.
Work with the billers in identifying problem areas with the current coding process and engaging them with solving the problems.
Requirements
Knowledge of ICD-10-CM, HCC, CPT and CPT II coding guidelines; medical terminology; anatomy and physiology; state and federal Medicare reimbursement guidelines; English grammar and usage.
Ability to research and analyze data, draw conclusions, and resolve issues; read, interpret, and apply policies, procedures, laws, and regulations.
Ability to read and interpret medical procedures and terminology.
Ability to develop training materials, make group presentations, and to train staff
Ability to exercise independent judgment
Excellent written and verbal communication skills to prepare reports and related documents and to maintain working relationships with physicians and other staff.
Ability to maintain a high level of integrity and confidentiality of medical information.
Mastery level knowledge of ACO and Value-based contracts and coding requirements
Good problem-solving skills
Dental coding skills a plus
Education and Experience:
CPC certified required
Minimum of two years of experience in medical record coding, or the;
Equivalent combination of experience, education, and training that would provide the
Required knowledge and abilities.
Ability and experience in the training and teaching of those at differing experience and educational levels.
Physical Requirements:
Prolonged periods of sitting at a desk and working on a computer.
Must be able to lift up to 15 pounds at times.
About the Company
HCCH provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements, HCCH complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.
HCCH conducts background checks on all final candidates. Employment is contingent upon a clear background check or approval of the CEO