Under direct supervision of the Manager of Professional Services, performs functions as both coding auditor and educator and is responsible for providing oversight on education and audits of medical records for compliance with federal coding regulation and guidelines. This position is responsible for the coordination of auditing and education in support of achieving organizational strategic initiatives. The position has a shared responsibility to assist in achieving teams goals. 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 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.
- Ensures compliance with Federal Coding Documentation Guidelines and PCH/PCMG official coding policies.
- Audits medical record documentation of Ambulatory services to verify the accuracy and specificity of all assigned codes, modifiers, POS, units, etc.
- Provides documentation/coding education to coders and providers to maximize accuracy, completeness and compliance with accepted standard of practice and current coding guidelines.
- Maintains current department policies related to coding and documentation requirements.
- Collaborates with other disciplines and departments as a change agent and participated in the evaluation of outcomes.
- 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.
- Educates 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.