Under direct supervision of the Manager of Professional Services, performs audits of medical records for compliance with federal coding regulation and guidelines. Uses knowledge of PCH policies and procedures to provide a second level review of all Codes (CPT, EM, ICD-10 etc.) to achieve and maintain compatibility with Government and PCH billing requirements and compliance standards. This position collaborates with Coding Educator to provide training and education to Coding and Medical Staff. This position also assists with coding production, as needed; reviews and resolves coding issues related to billing; researches complex coding issues and participates in process improvements related to coding and EM management.
- Family-Centered care that focuses on the need of the child first and values the family as an important member of the care team
- Excellence in clinical care, service and communication
- Collaborative within our institution and with others who share our mission and goals
- Leadership that set the standard for pediatric health care today and innovations of the future
- Accountability to our patients, community and each other for providing the best in the most cost-effective way.
Ensures compliance with Federal Coding Documentation Guidelines and PCH/PCMG official coding policies.
- Audits medical record documentation to identify under/over coding.
- Maintains current department policies related to coding and documentation requirements.
- Researches and resolves complex coding/documentation issues.
- Performs internal coding and documentation quality reviews of coded Ambulatory services and professional fee assignment of medical records to verify the accuracy and specificity of assigned codes in accordance with documentation guidelines.
- Communicates with providers regarding medical record documentation in order to maximize accuracy, completeness, and compliance with accepted standards of practice and current coding guidelines.
- Reviews accounts, when requested by the Physician Billing and Revenue Cycle Department and other clinical departments to research and resolve coding issues related to billing.
- Participates in continuing education activities to maintains current credentials, as well as to enhance knowledge and skills.
- Reviews Medical records for appropriate Diagnosis/EM/CPT/HCPCS codes and modifiers in compliance with Official Documentation Guidelines for Coding and Reporting as well as PCMG coding policies.
- Performs miscellaneous job related duties as requested.