Physician Coding Ed Specialist- St Pete

This opportunity is a hybrid role requiring occasional on-site presence and residency in the St. Pete, 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 (90% remote, 10% on-site). Full-time exempt position with a flextime plan, including the possibility of occasional early morning or evening hours. Schedule: Monday through Friday, day shift.

Responsibilities

• Responsible for internal auditing and analyzing professional coding for all service lines.
• Monitor audit results closely to identify potential coding inaccuracies.
• Provide the Department/Practice with needed support in identifying coding errors.
• Work with practices to ensure services are captured accordingly.
• Provide additional education to practices, providers, and coders as needed.
• Ensure medical documentation follows governmental payers, managed care, and private insurance 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.
• Develop and present educational programs to physicians, physician extenders, and physician offices.
• Effectively communicate best-practice physician coding feedback with physicians, non-physician providers, office staff, administration, practice managers, and team members.
• Identify and solve complex trending coding issues affecting the physician revenue cycle; provide necessary feedback to correct claims and recover underpaid amounts.
• Collaborate with the Physician and Professional Services Central Business Office to ensure appropriate follow-up of patient accounts for coding accuracy and payor guideline reimbursement.
• Maintain professionalism and positive interactions with all Orlando Health departments.
• Provide statistical reports to document 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 and distribute monthly summaries of physician coding opportunities.
• Research, identify, develop, and assist in implementing plans to resolve coding disputes with payors.
• Utilize resource materials from CMS, AMA, AHCA, and the federal registry to support coding practices.
• Perform physician queries for coding and documentation clarification during concurrent chart review.
• Serve as a preceptor to new coders.
• Develop and present educational programs to the Physician & Professional Services team, physicians, physician extenders, and coding team members.
• Maintain patient and coder confidentiality.
• Adhere to Standards of Ethical Coding, regulations, guidelines, and client-specific policies.
• Responsible for the development and training of staff within the Coding Department, including:
  • New providers and coders.
  • Testing, training, and mentoring incoming coders according to coding guidelines.
  • Existing providers.
• Collaborate with Physician Coding Leadership in monitoring coding quality.
• Participate in Health Plan Audits.
• Develop and implement coder enhancement strategies.
• Disseminate new governmental releases and information.
• Conduct basic in-house coder audits and in-service presentations during coders’ meetings.
• Provide daily support to assigned practice managers on coding-related questions.
• Maintain regular, punctual attendance consistent with Orlando Health policies and federal, state, and local standards.
• Comply with all Orlando Health policies and procedures.
• Perform other duties as assigned based on organizational 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 for proposal and report development.
• Associate degree required. Five (5) years of directly related work experience may substitute for the associate degree.
• Exceptional knowledge of Microsoft Office (Word, Outlook, PowerPoint) and moderate to expert experience with Microsoft Excel.
• Thorough knowledge of official coding guidelines as per AMA, AHA, and CMS, evidenced by a coding skills test result of 90% or better.

Qualifications

• 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 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, including:
  • Office, inpatient, bedside procedures, surgical coding.
  • Teaching and physician extender provider coding.
  • Experience with 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 benefits that go beyond the expected, including career-growing FREE education programs and well-being services to support you and your family through every stage of life. Benefits begin on day one and offer flexibility to support your passions.