Coding Quality Education Specialist

Audits

• Charts and reviews clinical records ensuring all diagnostic and procedural codes and modifiers strictly adhere to guidelines.
• Identifies trends in improper coding or other communication shortcomings that may lead to claim denials or audits.
• Complies with all medical coding guidelines and monitors evolving regulatory and industry changes.
• Provides targeted education, direct coaching, and facilitates training programs tailored to each medical specialty based on translating audit findings.
• Follows up and clarifies any information that is not clear with the rendering provider.
• Collaborates with IT and EHR teams to improve charge automation and optimize workflows.
• Conducts ad-hoc audits to ensure fidelity to coding guidelines.
• Analyzes medical records and identifies documentation deficiencies.

Expertise

• Expert for Southwest Network on accurate and efficient coding practices.

Non-Essential Functions

• Fulfills policies and procedures and adheres to the requirements of the Corporate Compliance Program.
• Ensures confidentiality of verbal and written information in accordance with HIPAA standards and Southwest Network policy, and adheres to the legal, ethical, and professional guidelines adopted by Southwest Network.
• Performs other duties as assigned.