Outpatient Coding Educator

About the role

Provides physician medical practice coding, billing, and documentation auditing for professional coding at Nuvance Health. Conducts routine quality assurance (QA) audits on Professional Coding team and compiles reports on their accuracy for leadership. Makes recommendations based on audit findings for educational programs for both coding personnel and clinical staff. Develops and delivers education to physicians and professional fee coders. Requires advanced expertise in medical terminology, anatomy, physiology, documentation, coding guidelines, state, and federal regulations.

Responsibilities

• Conducts high volume internal audits of physician practice medical records for documentation and coding accuracy.
• Develops and delivers education sessions for Nuvance coders and medical practice clinical personnel based on the audit findings and as needed or requested to reinforce proper documentation and coding consistent with Nuvance Health policies, State and Federal regulatory and guidelines, and maintaining compliance while optimizing revenue opportunities.
• Attends practice and service line meetings as needed or requested to deliver education and stay current with information that may affect professional coding and clinical personnel.
• Performs QA activities for professional fee coders and medical practice clinical personnel.
• Works closely with the Compliance department on audits, reporting, complaint coding issues etc.
• Researches CMS and NGS Medicare regulations, guidelines, bulletins, and other publications for impact to professional services.
• Monitors listservs such as CMS, Medicare, NGS, AAPC etc. and third-party payers for coding and billing guidelines and regulations, professional peer organizations' practices/policies/guidelines to help keep Nuvance physician practices current with coding and regulatory requirements and accepted compliance practices.
• Stays current with OIG Work Plan.
• Collaborates with professional fee coding team to identify errors, patterns, trends and variations in coding or documentation.
• Provides recommendations to Manager or Director to improve coding and documentation practices.
• Attends required educational sessions (webinars, conferences etc.) to maintain and enhance coding certification(s).
• Maintains and models Nuvance Health Values.
• Demonstrates regular, reliable, and predictable attendance.
• Performs other duties as required.

Education

• 5 Years demonstrated coding experience in appropriate application of coding and documentation guidelines.
• Specialized training in medical terminology, ICD-10-CM/CPT and E&M coding.
• Prior experience auditing in E&M Leveling facility and professional.
• Prior teaching/instructing experience in a healthcare setting.
• Certification from the American Academy of Professional Coders (AAPC) or the American Health Information Management Association (AHIMA) - CPC or CCS-P required.
• Certified Professional Medical Auditor (CPMA) or Certified Documentation Expert Outpatient (CDEO) required.

Working Conditions

• Manual: Little or no manual skills/motor coordination & finger dexterity.
• Occupational: Little or no potential for occupational risk.
• Physical Effort: Sedentary/light effort. May exert up to 10 lbs. force.
• Physical Environment: Generally pleasant working conditions.

Exempt: No

Pay

Salary Range: $29.65 - $55.55 Hourly