Ambulatory Coding Compliance Specialist
Posting Note: *Surgical coding experience strongly preferred*
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.
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.
Phoenix Children's Mission, Vision, & Values
To advance hope, healing and the best healthcare for children and their familiesVision
Phoenix Children's will be the leading pediatric health system in the Southwest, nationally recognized for exceptional care, innovative research and advanced medical education.
We realize this vision by:
- Offering the most comprehensive care across ages, communities and specialties
- Investing in innovative research, including emerging treatments, tools and technologies
- Advancing education and training to shape the next generation of clinical leaders
- Advocating for the health and well-being of children and families
- We place children and families at the center of all we do
- We deliver exceptional care, every day and in every way
- We collaborate with colleagues, partners and communities to amplify our impact
- We set the standards of pediatric healthcare today, and innovate for the future
- We are accountable for making the highest quality care accessible and affordable