Incumbent will be responsible for review and analysis of coding and compliance activities directly related to reimbursement for professional services in the Department of Surgery. Incumbent will perform audits of clinicians to ensure that documentation supports the service that was performed. Incumbent will be responsible for educating the clinicians on coding and compliance issues.
PRINCIPAL DUTIES AND RESPONSIBILITIES:
Responsible for preparing audits for each provider. These audits will include benchmarking against national averages.
Responsible for follow-up audits, as needed.
Responsible for tracking coding issues by provider and providing necessary education to improve coding.
Responsible for preparing reports and presenting findings to management.
Responsible for educating providers post-audit on coding and documentation regulations and requirements.
Responsible for reporting and resolving all billing issues discovered during provider audits.
Keep informed of third party regulations in billing/reimbursement and maintain files of coding publications.
Handle special projects as assigned.
Participate in continuing education programs to ensure that coding knowledge remains current.
Assist manager in reviewing external payer audits
Assist manager in performing all tasks related to coding and compliance.
Perform other duties as needed.
Ability to present findings and discuss issues with providers confidently and effectively
Strong attention to detail
Ability to interact with all levels of staff
Strong interpersonal, analytical, and presentation skills
Strong written and oral communication skills
Strong organizational skills
Excellent problem-solving skills
In-depth understanding and knowledge of ICD-10-CM and CPT coding
Ability to work both independently and as part of a team
Ability to work under pressure, multi-task, and meet deadlines
Familiarity with common office equipment and computer software, including MS Office and Database software
LICENSES, CERTIFICATIONS, and/or REGISTRATIONS:
Preferred: CPMA and/or CEMC
Required: High school diploma or GED Certificate
Preferred: Some college or Associate's Degree, Doctoral Degree
Field of Study (if applicable):
Required: Knowledge of CMS (Medicare and Medicaid) and other 3rd party payers' billing and documentation requirements is required
Preferred: American Academy of Professional Coders (AAPC) CPMA or CEMC, strongly preferred
Required: 5 years of experience in a healthcare setting including ICD-10-CM and CPT Coding experience is required
Brigham And Women's Hospital