Physician Coding Ed Specialist

This opportunity is a hybrid role requiring occasional on-site presence and residency in the Central FL area. At Orlando Health, we are ordinary people with extraordinary individuality, working together to bring help, healing and hope to those we serve. By daily embodying our over 100-year legacy, we have grown into a 3,900-bed healthcare organization that delivers care for more than 142,000 inpatient and 3.9 million outpatient visits each year.

About the role

Performs, develops, and implements coding-related efficiency processes to monitor professional coding to ensure optimal efficiency and follow controlling compliance guidelines with governmental and private payers. The Physician Coding Education Specialist is responsible for analyzing physician coding trends and providing education that will contribute to effective productivities.

Location: Hybrid, Remote 90% & On-site 10%
Status: Full Time (exempt)
Days: Monday through Friday
Shift: Day (flextime plan with the possibility of occasional early morning/evening hours)

Responsibilities

• Responsible for internal auditing and analyzing professional coding for all service lines.
• Monitor the audit results closely to identify any potential coding inaccuracy.
• Provide the Department/Practice the needed support in identifying coding errors.
• Work with the practice to ensure services are captured accordingly.
• Provide additional education to practices/providers/coders as needed and requested.
• Ensure that medical documentation follows Governmental payers, Managed Care, and private insurances guidelines.
• Review medical records to ensure accuracy of code assignment.
• Guide and educate coding team members by addressing errors, performance issues, and trends identified through reporting.
• Identify and communicate physician documentation and coding opportunities for improvement.
• Take an active role in developing and presenting educational programs to physicians, physician extenders, and physician offices.
• Effectively communicate best practice physician coding-related feedback with physicians, non-physician providers, physician office staff, administration, practice managers, and team members of the Physician and Professional Services Central Business Office.
• Take the initiative to identify and solve complex trending coding issues affecting the physician revenue cycle and provide the necessary feedback to correct claims on a go-forward basis as well as recovered underpaid amounts.
• Collaborate with Physician and Professional Services Central Business Office to ensure appropriate and complete follow-up of patient accounts to ensure coding accuracy for payor guideline reimbursement.
• Maintain a high level of professional demeanor and dress in all settings.
• Provide statistical reports to deliver accurate documentation of ongoing internal coding efficiency processes.
• Conduct focused physician reviews as needed and provide data to the manager.
• Maintain a 90% physician coding accuracy rate.
• Attend payor, departmental, and interdepartmental meetings as required.
• Prepare/distribute information summarizing opportunities with physician coding monthly.
• Research, identify, develop, and assist in the implementation of a plan of action to resolve coding disputes with payors.
• Utilize resource material available in the department, CMS, AMA, and AHCA and federal registry to support coding practices.
• Perform physician queries for coding and documentation clarification during the concurrent chart review process.
• Serve as a preceptor to new coders.
• Maintain patient and coder confidentiality.
• Adhere to Standards of Ethical Coding, all applicable regulations and guidelines, and all client-specific policies.
• Responsible for the development and training of staff within the scope of Coding Department structure, including:
  • New providers
  • New Coders
  • Testing, training, and mentoring incoming coders according to the coding guidelines and individual skills for the Division for which the coder will be assigned.
  • Existing providers
• Collaborate with Physician Coding Leadership in monitoring coding quality.
• Participate in Health Plan Audits.
• Develop and implement coder enhancement strategies.
• Provide in-service presentations during coders’ meetings.
• Provide daily support to all assigned practice managers on their coding-related questions.
• Maintain reasonably regular, punctual attendance consistent with Orlando Health policies, the ADA, FMLA, and other federal, state, and local standards.
• Maintain compliance with all Orlando Health policies and procedures.
• Work in collaboration for testing, training, and mentoring incoming coders according to the coding guidelines and individual skills for the Division for which the coder will be assigned.
• Other duties as assigned based on organization needs and projects.

Requirements

• Excellent knowledge of CPT-4, ICD-10-CM/PCS, and HCPCS coding principles, governmental regulations, protocols, and third-party payer requirements pertaining to billing, coding, and documentation.
• Knowledge of medical terminology.
• Experience working with Electronic Medical Records.
• Ability to work independently.
• Strong interpersonal and presentation skills paired with advanced written and verbal communication skills.
• Strong analytical and writing skills required for proposal and report development.
• Associate degree required. Five (5) years of directly related work experience may substitute for the associate degree.
• Possess exceptional knowledge in Microsoft Office Word, Outlook, and PowerPoint as well as moderate to expert experience with Microsoft Excel.
• Thorough knowledge of official coding guidelines as per AMA, AHA, and CMS as evidenced by results of coding skills test of 90% or better.
• Must maintain one (1) of the following national certifications:
  • Certified Professional Coder (CPC) through the American Academy of Professional Coders
  • Certified Coding Specialist (CCS) through the American Health Information Management Association (AHIMA)
  • Certified Coding Specialist-Physician (CCS-P) through the American Health Information Management Association (AHIMA)
  • Certified Medical Coder (CMC) through Practice Management Institute
  • Certified Professional Medical Auditor (CPMA)
  • CEMA certification via National Alliance of Medical Auditing Specialists
• 5-6 years of professional-based coding experience is required. Professional-based coding experience must include Office, Inpatient, Bedside Procedures, Surgical Coding, Teaching & Physician extender provider coding, multiple specialties is desired.
• Level one (1) Trauma hospital experience is preferred.
• Experience with a large organization, multi-location, multi-specialty with high volume providers is preferred.

Benefits

Orlando Health is committed to providing you with benefits that go beyond the expected, with career-growing FREE education programs and well-being services to support you and your family through every stage of life. We begin your benefits on day one and offer flexibility wherever possible so that you can be present for your passions.