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Job Summary:

The Provider Coding Educator is coordinates medial record coding audits, conducts provider training sessions on diagnosis coding and develop training guidelines, process and procedures for medical record coding in an effort to maximize reimbursement.

Job Requirements:
Education:

• High School Diploma or GED
• Bachelor’s Degree preferred

Work Experience:

• 5+ years of outpatient office procedure coding
• 2+ years of training providers on chart documentation and coding guidelines
• Experience with delivering presentations, conducting one on one education with providers, teaching a coding class, or speaking at coding seminars

Required Licenses/Certifications:

• Medical Coding Certificate – RHIT, CPC, or CCS-P
• ICD10 Proficiency

Additional Knowledge, Skills and Abilities Required:

• Federal laws and regulations affecting coding requirements
• Working knowledge of payor guidelines
• Knowledge of revenue cycle and billing practices
• Knowledge of EMR required, eClinical Works and/or Epic preferred
• Knowledge of PowerPoint, Microsoft Word and Excel
• Strong communication skills.
• Excellent interpersonal skills
• Organizational skills
• Denial Management

Essential Functions

• Perform coding audits to ensure procedure codes are accurate based on diagnosis.
• Reviews medical record documentation that supports billing, risk management and legal requirements.
• Maintain accurate records of the provider audits and make any recommendations for changes in policies and procedures, guidelines and training programs.
• Work closely with Corporate Compliance to identify areas of opportunity on medical record coding and documentation for Providers.
• Work with Compliance to conduct baseline audits and re-audits and provide feedback on areas of improvement.
• Develop and implement onsite education and training to all provides to ensure accurate documentation and medical coding in real time.
• Provide consultation to Providers to improve medical record documentation and ensure proper coding in effort to maximize claim reimbursement.
• Develops and implements coding education for new hire providers.
• Performs data analysis and evaluate denial reports of all payers; Develop reports on physician statistics regarding coding compliance, benchmarking and revenue enhancement opportunities.
• Participates in committees and meetings as it pertains to coding, billing, and documentation.
• Prepares written reports of the audit findings by provider/practice.
• Assists with claim denial reports to ensure optimal reimbursement.
• Provides clarification on GoHealth coding and compliance policies.
• Meets with the Compliance Committee as needed to review audits, discuss concerns, and develop processes/procedures.

Note: this job description is not inclusive of all the duties of the position. You may be asked by leaders to perform other duties. Management reserves the right to revise this position description at any time.

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All qualified persons are granted an equal opportunity for employment without regard to race, color, religion, sex, sexual orientation and gender identity or expression, age, national origin, citizenship status, disability, genetic information, medical condition, family care leave status, pregnancy or pregnancy-related condition, otherwise qualified disabled or veteran status. The company will comply with all fair employment laws in each of the jurisdictions where we conduct business.

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