La Crosse, WI 54601
Love + medicine is who we are, it's what we do, it's why people want to work here. If you’re looking for a job to love, apply today.
Schedule Weekly Hours:
40This is a 1.0 FTE = 80 hours every 2 weeks. This position will be working remote, however candidates must be within a reasonable driving distance to be able to come in for occasional meetings and training. We can only accept candidates from WI, IA and MN.
Job Description:
The Coding and Documentation Education Specialist is responsible to teach and provide expert advice in CPT (Current Procedural Terminology) and ICD (International Classification of Diseases) coding guidelines, clinical documentation, risk adjustment methods, billing and revenue integrity policies, denials analysis and prevention to the medical staff and associate staff. The Education Specialist works under the direction of the Mid-Revenue Cycle Director in partnership with the Medical Staff's liaison with Revenue Cycle to teach, guide, and advise providers as well as operational and clinical leadership. The Education Specialist proactively analyzes and interprets the revenue and reimbursement implications of clinical documentation as it is translated into ICD and CPT codes, charge capture, and risk adjustment methods. The research, analysis, education and recommendations contribute to compliant optimization of revenue and quality measures. Also, prepares and leads medical staff and associate staff education on CPT and ICD-10 related payer coverage policies, documentation of medical necessity, risk adjustment factors, e.g., hierarchical condition categories (HCC). Interprets and translates coding, payment, and reimbursement policies and regulations for the benefit of leaders and staff within and outside of the Revenue Cycle to optimize communication, effective change management, and continuous improvement to achieve and sustain results.
Major Responsibilities:
1. Partner with Administrative Directors and Department Chairs/Section Chiefs to prepare and deliver to all licensed independent practitioners clinically pertinent ICD-10 and CPT coding/charge capture education and training, including required documentation and national and local coverage determinations to achieve and sustain compliance with government and commercial payer regulations/requirements.
2. Employ a variety of teaching/learning strategies, methodologies and technologies (presentation skills, facilitation skills, adult learning principles, small/large group exercises, knowledge of age-related competencies, computer skills and e-learning) to achieve and sustain results.
3. Use analytical reasoning and critical thinking skills to perform periodic quality reviews and audits of provider documentation and code selection to identify potential risks or improvement opportunities. Prepare, analyze and interpret measures of provider coding, documentation and charge capture performance, e.g., national E&M averages based on provider specialty. Provide regular feedback of results with consultation and education to achieve and sustain timely billing and optimum reimbursement within the regulations and guidelines of the payers.
4. Demonstrate in depth knowledge and technical expertise in code sets including CPT, HCPCS, ICD-10 as well as the current national, regional, and local payer policies for coding, billing, and claims processing. Partner with leaders in Revenue Cycle and Clinical Documentation Improvement to monitor, research, translate, interpret, and communicate new developments and changes that will impact provider documentation and coding.
5. Interpret, communicate and advise medical and associate staff as well as clinical operational leaders, taking the initiative to facilitate the creation of solutions and process change.
6. Respond to consultation requests from Administrative Directors and individual providers for professional-level analysis, reporting and recommendations related to clinical documentation, charge capture/coding, medical billing processes and practices, or denials prevention. Meet with clinical leaders to understand the nature and objectives of requests; research and analyze data; draft reports, documents and other materials for practitioners; assists in presentations and communications. May proactively work with multidisciplinary teams within the organization to reduce denials through reporting, education, and trend analysis.
7. Collaborate and partner with Coding Supervisors as well as colleagues in Revenue Cycle or Compliance to research or interpret coding guidelines and payer’s claims processing or coverage policies.
8. Manage multiple assignments and requests simultaneously and appropriately prioritize ad hoc requests.
9. Consistent application of leadership skills, conflict management, change management and team building skills in order to ensure a productive and mutually respectful environment.
10. Demonstrate precision and professionalism in both written and verbal communication skills. Write clearly and informatively; edit work for spelling and grammar; vary writing style to meet needs; present numerical data effectively. Communicate and present complex information internally and externally using clear and effective oral and written communication skills.
11. Travel to regional clinics as required to fulfill major responsibilities of the job.
12. Performs other job-related responsibilities as requested.
Education and Learning:
REQUIRED
Bachelor's degree in a related field Also required, evidence of completion of coding training including ICD-10 and CPT through a recognized professional association (AAPC or AHIMA) or accredited school.
DESIRED
Bachelor's degree in Healthcare or Business Administration or Health Information Management or Nursing
Work Experience:
REQUIRED
3-4 years of experience in healthcare coding, billing, insurance follow-up or reimbursement with a Bachelor's degree.
DESIRED
1 year of experience in Medicare outpatient and inpatient coding and reimbursement methodologies as well as non-Medicare payers coding and reimbursement.
License and Certifications:
REQUIRED
Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) or Certified Coding Specialist - Physician Based (CCS-P) or Certified Clinical Documentation Specialist (CCDS) or Registered Health Information Technician (RHIT) or Registered Health Information Administrator (RHIA)
Valid Driver's License (DL)
Age Specific Population Served:
Nonage Specific (N/A)
OSHA Category:
Category III - No employees in this job title have a reasonably anticipated risk of occupational exposure to blood and/or other potentially infectious materials.
Environmental Conditions:
Not substantially exposed to adverse environmental conditions (as in typical office or administrative work).
Physical Requirements/Demands Of The Position:
Sitting Continually (67-100% or 8 hours)
Walking/Standing Occasionally (6-33% or 3 hours)
Driving Rarely (1-5% or .5 hours)
Reaching - Below Shoulder Occasionally (6-33% or 3 hours)
Repetitive Actions - Pinch Forces Rarely (1-5% or .5 hours) Pounds of force 0-25
Repetitive Actions - Fine Manipulation Occasionally (6-33% or 3 hours)
If you need assistance with any portion of the application or have questions about the position, please contact [email protected] or call 608-775-0267
Equal Opportunity Employer