The Coding Quality Educator conducts risk-based coding quality monitoring of provider services across United Musculoskeletal Partners (UMP) practices to validate CPT and ICD-10 code assignment, adhering to AMA Official Coding and Reporting Guidelines, CMS and other agency directives for ICD10-CM and CPT coding, as supported by clinical documentation in the medical record. This includes performing internal reviews, participating in external audits, and delivering coding/documentation education and training to providers and coders. Responsible for monitoring coding activities of all UMP practices in support of the organization’s adherence to applicable CMS requirements, AMA Official Coding and Reporting Guidelines, government regulations and internal policies. Serves in an advisory capacity to leadership and providers as it relates to documentation, coding, and regulatory compliance.

As a key member of the Coding team the Coding Quality Educator:

· Conducts coding, billing, and documentation monitoring within established timeframe. Identifies need for new policy development/changes to meet regulatory requirements.

· Prepares clear and accurate review findings and recommendations in written reports that will be used for advising and educating providers, coders, and management throughout the organization.

· Understands, interprets, and applies coding guidelines for coding and billing.

· Conducts monthly monitoring reviews of medical records to determine coding accuracy of all documented diagnoses and procedures. Reviews claims to validate submitted codes and abstracted data including but not limited to ICD-10 CM codes, CPT’s, HCPCS, modifiers, and place of service.

· Identifies documentation gaps (lacking documentation, missed physician queries, etc.) that impact coding accuracy.

· Prepares presentations and delivers education sessions to providers, coders, and other members of revenue cycle teams. Conducts one-on-one and group sessions with providers and other members of the organization via teleconferencing platforms.

· Stays current with Official Coding and Reporting Guidelines, CMS and other agency directives for ICD-10-CM and CPT coding. Completes online education courses and attends mandatory coding workshops and/or seminars (ICD-10 and CPT updates) for Physician Services coding. Reviews AHA and CPT quarterly coding update publications.

· Reviews and prepares response to external payer and compliance audits, including but not limited to RAC audits and payer audits.

· Serves as a subject matter expert on coding/billing topics.

· Responsible for working with other departments to respond to coding queries.

QUALIFICATIONS

EDUCATION AND EXPERIENCE

· 3+ years of relevant experience in a professional coding auditor and/or coding educator capacity required.

· 3+ years orthopedic surgery and/or Evaluation and Management (E/M) coding experience. Other surgical specialties considered.

· CPMA certification required

· Must have current CPC, COSC or CEMC certification from AAPC. Will consider CCS-P or CCS certification from AHIMA, with relevant work experience.

· Associate degree in health information management, health services administration, or related field desired.

· Proficiency in MS Office products - intermediate to advanced knowledge of MS Excel.

SKILLS/ABILITIES

· Must successfully pass pre-hire coding assessment.

· Ability to consistently and accurately review coding of physician services encounters.

· Ability to create clear and concise feedback reports and maintain productivity standards.

· Strong technical knowledge of Centers for Medicare & Medicaid Services (CMS) regulatory guidelines, including ICD-10 CM, CPT, and HCPCS Procedure Coding, and official coding guidelines.

· Knowledge of disease pathophysiology and drug utilization.

· Knowledge of NCCI edits structure.

· Must be detail oriented and have the ability to work independently.

· Computer knowledge of MS Office, including Word and Excel.

· Must display excellent interpersonal skills.

· Ability to demonstrate initiative and discipline in time management and assignment completion.

· Ability to work in a virtual setting under minimal supervision.