PROFESSIONAL CODING COMPLIANCE SPECIALIST (ON-SITE)

Essential Duties

• Completes timely audits of assigned providers and coders for accurate, complete, and compliant ICD-10-CM and CPT/HCPCS code assignment, ensuring that documentation supports the diagnoses reported, E/M level selected, and CPT/HCPCS codes submitted for services rendered during the episodes of care reviewed
• Reviews audit findings with assigned providers and coders, providing real-time education on opportunities identified and offering objective supporting documentation (e.g., current coding conventions, regulatory/payor-specific requirements, risk-adjustment guidelines, organization-specific policies) to support findings and use as reference
• Documents audit results in designated Excel log as soon as review is completed
• Immediately reports adverse audit trends, potential areas of risk, and compliance concerns to management
• Affords assistance in creating and publishing monthly provider newsletter
• Collaborates with coding compliance team and provider-focused coding manager to develop and maintain current coding guidelines for Riverside Medical Group as a whole and its specialists to ensure compliance and consistency across practices and their assigned coding teams
• Develops and presents provider and coder education programs as requested
• Affords assistance in maintaining orientation materials for new providers, residents, and fellows that reflect current coding and documentation rules and requirements
• Affords assistance in orienting and educating new team members as requested
• Serves as coding compliance resource to Riverside Medical Group and Riverside Medical Center as requested
• Affords assistance in provider-focused coding and charge entry as needed to meet fiscal deadlines and backfill staff vacancies

Required Experience

• Minimum three years current ICD-10-CM and CPT/HCPCS (including E/M assignment) coding experience in a multi-specialty medical practice or comparable coding experience required
• AAPC/CPC (Certified Professional Coder) required
• AAPC/CPMA (Certified Professional Medical Auditor) strongly recommended at hire; required within two years of hire
• AAPC/CRC (Certified Risk-Adjustment Coder) strongly recommended
• Associate degree in health-related field preferred
• Formal education in ICD-10-CM and CPT/HCPCS coding principles and assignment maintained by relevant continuing education

Employee Health Requirements

• Exposure/Sensory Requirements: Exposure To Chemicals: NAVideo Display Terminals: Average Blood and Body Fluids: None TB or Airborne Pathogens: None Sensory Requirements (speech, Vision, Smell, Hearing, Touch): Speech: Needed for presentations/training, telephone communication, facilitate meetings. Vision: Needed to read computer screens and printouts, memos, communications, documentation, and literature. Smell: Electrical/fire safety. Hearing: Needed for telephone communications, meetings, and equipment operating characteristics.Touch: Needed to write, do computer entry, filing.
• Activity/Lifting Requirements: Percentage of time during the normal workday the employee is required to: Sit: 55% Twist: 0% Stand: 20% Crawl: 0% Walk: 20% Kneel: 0% Lift: 0% Drive: 0% Squat: 0% Climb: 0% Bend: 5% Reach above shoulders: 0% The weight required to be lifted each normal workday according to the continuum described below: Up to 10 lbs: Frequently Up to 20 lbs: Occasionally Up to 35 lbs: Occasionally Up to 60 lbs: Occasionally Up to 75 lbs: Not Required Up to 100 lbs: Not Required Over 100 lbs: Not Required
• Description and explanation of the lifting and carrying requirements: Putting away supplies. Lift above the head occasionally to place boxes on high storage shelves. Carry boxes up and down the stairs - distances up to 100 feet. Maximum consecutive time (minutes) during the normal workday for each activity: Sit: 30 Twist: .5 Stand: 30 Crawl: 0 Walk: 2 Kneel: 0 Lift: 5 Drive: 30 Squat: 1 Climb: .5 Bend: .5 Reach above shoulders: .5 Repetitive Use Of Hands (Frequency Indicated): Simple grasp up to 15 lbs. Normal weight: continuous Pushing &pulling Normal weight: 50-200# Fine Manipulation: Computer Keyboard and mouse. Repetitive use of foot or feet in operating machine control: Not Required Environmental Factors & Special Hazards Environmental Factors (Time Spent): Inside hours: 8.0 Outside hours : 0 Temperature: Normal Range Lighting: Average Noise levels: Average Humidity: Normal Atmosphere: Special Hazards: Protective Clothing Required: Gloves when handling blood and body fluids.

Pay Range

USD $28.83 - USD $37.13 /Hr