Job Summary

This position is responsible for implementing the daily coding, billing compliance and auditing functions of FMG. The coding compliance educator supports the coordinators in conducting research, recommending and updating standard policies and procedures, and developing training materials. These standards are in adherence with applicable federal and state law, and the program requirements of federal, state and private health plans. The coding compliance educator monitors provider E/M profiles and conducts audits and education to ensure appropriate reimbursement and compliance with all regulatory guidance. This position is responsible for identifying compliance issues and analyzing practice patterns and recommending changes to policies and procedures. The coding compliance educator supports the implementation of necessary changes with clinical departments through education of providers and staff. The coding compliance educator maintains the accuracy and completeness of provider audits in the auditing software application. This position meets regularly with the coordinator and Supervisor of Coding and Billing Compliance to ensure risks are identified and prioritized across the revenue cycle function.

Essential Duties

• Provide coding education to physicians and their support staff in their designated clinics.
  
• Develops and maintains charge slips to reflect accurate coding.
  
• Conducts research to update: educational materials for providers and coding specialists and standard policies and procedures.
  
• Performs audits and provide feedback and education in accordance to Coding Compliance Audit and Monitoring Work Plan.
  
• Interprets changes in the external regulatory environment and stays current with coding updates. Assists coordinator in developing and updating FMG policies and training materials based on trends and risk areas. Plans and conducts on-going training with physicians and support staff.
  
• Responds to questions from providers, managers, billing office and others relating to CPT and ICD-9-CM coding, rules & regulations, reimbursement, and documentation requirements.
  
• Maintains project work lists and meets deadlines.
  
• Other: Performs related duties as required.

Education

• High School Diploma or GED required.

Experience

• 2-4 years experience in ICD-9-CM and CPT coding in acute care or ambulatory care setting required
  
• 2 years experience in professional fee coding and documentation auditing required
  
• 2 years experience in provider education and training required
  
• Experience in providing group education preferred

• Coding certification through AHIMA (CCS, CCS-P) or the AAPC (CPC) required
  
• Certified Professional Medical Auditor (CPMA) preferred

Additional Responsibilities

• Demonstrates a commitment to service, organization values and professionalism through appropriate conduct and demeanor at all times.
• Adheres to and exhibits our core values:
  Reverence: Having a profound spirit of awe and respect for all creation, shaping relationships to self, to one another and to God and acknowledging that we hold in trust all that has been given to us.
  Integrity: Moral wholeness, soundness, uprightness, honesty and sincerity as a basis of trustworthiness.
  Compassion: Feeling with others, being one with others in their sorrows and joys, rooted in the sense of solidarity as members of the human community.
  Excellence: Outstanding achievement, merit, virtue; continually surpassing standards to achieve/maintain quality.
• Maintains confidentiality and protects sensitive data at all times.
• Adheres to organizational and department specific safety standards and guidelines.
• Works collaboratively and supports efforts of team members.
• Demonstrates exceptional customer service and interacts effectively with physicians, patients, residents, visitors, staff and the broader health care community.