Serves as the subject matter expert and resource for provider coding education, coding staff education, coding related questions, and insurance denials. Responsible for developing a work-plan to conduct financial and other specified audits so that appropriate education can be developed, prioritized, and delivered to providers and coders in NCPS. Analyzes and trends data to identify areas of opportunity related to documentation and coding. Educates providers regarding correct documentation per CMS guidelines to ensure the organization is billing appropriately. Stays current on coding updates and communicates changes to providers and coders in a timely manner.
Job Specific Duties
Using a comprehensive education plan, provides direct feedback regarding coding and documentation to providers and coders within NCPS.
Establishes a communication plan to ensure necessary changes have been implemented successfully and works to troubleshoot problems or issues that arise. Keeps clear documentation on all education provided.
Manages audit reports that outline sound recommendations for improvements to procedures, operational efficiencies and continued compliance.
Performs follow-up reviews to ensure implementation of agreed-upon management action plans. Communicates the potential risks, issues and opportunities with senior leaders to promote a strong compliance culture.
Prepares and maintains a comprehensive education program for providers and coders on ICD10 and CPT coding guidelines and updates.
Utilizes data to trend and identify root causes.
Stays abreast of regulatory changes related to coding and communicate these changes to providers and staff.
Serves as a resource to evaluate coding opportunities for businesses and programs that are new to NCPS.
Researches and resolves claim denials designated as coding related.
Minimum Job Requirements
Bachelor's Degree Bachelor's Degree in Business Administration, Health Information Management, Nursing or related field (OR) 5 years of relevant experience.
Certified Professional Coder, Certified Coding Specialist-Physician, and/or Registered Health Information Technician.
3-5 years experience of physician coding and auditing.
Knowledge, Skills, and Abilities
Able to conduct work with the highest integrity.
Demonstrated ability to collaborate and work with physicians, providers, IT, operation leaders along with revenue cycle vendors (not limited to coding company, auditors, and billing & collection).
Strong verbal and written communication skills.
Able to establish credibility and respect within a medical group.
Able to create and follow just in time processes and support efficient work flow.
Strong problem solving and critical thinking skills.
Strong financial, business and operational acumen.
Primary Location :
Florida-Miami-Nicklaus Children's Hospital - Main Hospital Campus
Nicklaus Children’s Health System, is the region’s only healthcare system exclusively for children. In addition to Nicklaus Children’s Hospital and a growing number of outpatient centers located throughout the tri-county area, the health system includes Nicklaus Children’s Hospital Foundation, the organization’s fundraising arm; Nicklaus Children's Pediatric Specialists, a nonprofit physician practice subsidiary; a management services organization, and an ambulatory surgery center. Our vision is to be where the children are. Ultimately, this means being there through all stages of health and life, both physically and emotionally. To be a trusted partner to children and their families, not only in times of illness, but throughout their life journey. Our mission is to inspire hope and promote lifelong health by providing the best care to every child.