Quality Coding Specialist (Revenue Operations and Coding)

The primary purpose of the Quality Coding Specialist position is to assign appropriate diagnosis and procedure codes to professional services that come through the Revenue Operations & Coding department. This position will be responsible for performing high level complex audit reviews for physician documentation. The auditor is to ensure charges submitted by the provider are in accordance with the coding and auditing rules and regulations, as set forth by the Centers for Medicare and Medicare Services, American Medical Association, as well as other payor and institutional guidelines. 

KEY FUNCTIONS:

Essential functions of the job include, but not limited to:

• Manually performs diagnosis and procedural coding by utilizing the International Classified Disease, Clinical Modification (ICD-10-CM) and the Current Procedural Terminology (CPT 4) classification systems to select appropriate codes.

• Performs a designated number of departmental audits to identify trends and opportunities within the departments.  Auditors demonstrate high decision making skills by reviewing provider’s documentation to ensure compliance with the coding and documentation rules and regulations set forth by the American Medical Association, Centers for Medicaid and Medicare Services, as well as other individual payers.

• Auditors will use the MD Audit Enterprise program to enter the results of their audits.

• Auditors will perform charge corrections for those services that are not supported by the provider’s documentation; and subsequently, schedule meetings to provide education to those designated providers and departments.

• Initiate consistent and ongoing education, including appropriate PowerPoint presentations and MD Audit reports, for each individual department as well as individual providers and others regarding the coding and/or auditing rules and regulations, or other pertinent issues related to coding.

• Assign appropriate modifiers, and apply guidelines as indicated through the Limited Coverage Diagnosis (LCD), as well as the National Correct Coding Initiative (CCI).

• Communicate effectively with providers and administrative staff using effective written and verbal communication skills, and demonstrating good interpersonal skills.

• Collaborate with the Institutional Compliance Billing department on consistent auditing processes and for developing provider education strategies.

• Compile reports with pertinent statistical data for review by management.

• Meet or exceed department production & accuracy standards.

• Report problems/concerns to management.

• Must have the ability to work independently without close supervision.

• Must exercise good judgment in making decisions in regard to coding and/or auditing outcome.

• Must be flexible and adapt to changing work assignments.                          

• Attend training & institutional classes to maintain current knowledge of coding & auditing rules.

Other duties, as assigned.

CORE COMPETENCIES

·         IC – Develop Oneself:

Pursue learning and self-development; actively seek feedback; transfer learning into next steps.  

·         IC – Self Confidence:

 Recognize own knowledge, skills, and abilities; respond to challenging situations with confidence; understand limits in self. 

·         IC -  Self-Motivation: 

Set high standards of performance; pursue goals with energy and persistence; drive for results and achievement. 

·         IC -  Written Communication:

                    Convey information clearly and concisely through both formal and informal documents; adapt writing to style to fit the audience. 

·         IC -   Analytical Thinking:

                    Gather relevant information systematically; break down problems into simple components; make sound decisions.

·         IC -   Innovative Thinking:

 Approach problems with curiosity and open-mindedness; offer new ideas, solutions and/or options. 

·         IC -   Strategic Thinking:

                      Define strategic goals and issues clearly; apply broad knowledge and experience when addressing strategic issues; foresee obstacles and opportunities relating to change or improvement.     

·         IC -   Inspire Trust:

                      Show consistency among principles, values, and behavior; gain the confidence and trust of others.