The Lead Educator Professional Services Coding is a primary resource to the team to develop education process and templates; identify PCMG/PCP needs through industry engagement and data; provide technical and professional support as the team members grow proactive and professional relationships; create targeted education to optimize the quality and accuracy of provider documentation and billing opportunities. This position has the ability to resolve high complexity issues, acts as a subject matter expert and demonstrates leadership through education, coaching and process/tool development for the Education team. As a part of the Education development and in coordination with Phoenix Children`s Annual Compliance plan, this position is also responsible for performing education and audits of medical records for compliance with federal coding regulation and guidelines under direct supervision of the Manager of Professional Services. 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 documentation, 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.
- Assists Manager/Leadership with development and optimization of processes, tools, and templates - acting as a subject matter expert for implementation of change.
- Assists Manager/Leadership with monitoring activities and direction of resources to ensure successful progress of established coding and education plans.
- Ensures compliance with Federal Coding Documentation Guidelines and PCH/PCMG official coding policies.
- 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.
- Educates and Communicates with providers and coders 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 maintain 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.