The MID REVENUE CYCLE CODING EDUCATOR SR serves as the subject matter expert and educational resource for any medical record coding and patient charge-related issues. This position provides education and training to clinical providers, nurses, and Revenue Integrity (RI) and Health Information Management (HIM) staff. The position is responsible for: Designing, creating, and implementing educational and training curriculum to initiate new processes resulting from initiatives, coding-related projects, and general coding-related matters driven by business needs. Creating the audit and quality reviews schedule for the fiscal year, adding a contingency plan for unexpected reviews and business priorities driven by external matters. Reviewing and communicating the CMS changes and their impact to RI and HIM operations. Conducting monthly audits and quality reviews for providers, nurses and Revenue Integrity (RI) and Health Information Management (HIM) staff to identify compliance opportunities with clinical documentation and coding and charging guidelines. Leading projects aimed to review and improving the quality of the clinical documentation in the patient record and final coding for both professional and technical billing. Resulting in the creation of curriculum specific to clinical services and tailored to individual stakeholders.Reviewing and approving the work completed by the Mid Revenue Cycle Coding Educators prior to distribution, implementation, and educational venue updates.Reviewing and approving the education and training calendar to onboard RI and HIM, new team members. Position ensures the sign-off of the education program as documentation for the new team member's 90-day introductory period.
Minimum Experience Required:
- Bachelor's degree plus six (6) years of health care coding experience with ICD-10-CM and ICD-10-PCS. CPT and HCPCS classification systems; inclusive of a minimum of two (2) years of professional practice medical coding auditing experience OR facility Outpatient coding auditing experience,
(OR)
- An Associate's degree and an additional two (2) years of experience as stated above may be considered (for a total of 8 years' experience). required.
(OR)
- A High School Diploma/GED and ten (10) years of experience as stated above, may be considered.
Minimum Licensure:
Any "one" of the following certifications is required:
- (CCS) Certified Coding Specialist
- (CPMA) Professional Certified Medical Auditor
- (CPC) Certified Professional Coder
- (COC) Certified Outpatient Coding
- (CCS-P) Certified Coding Spec-Phys
- (RHIT) Reg Health Info Technician
- (RHIA) Reg Health Info Administrator
- (CIC) Certified Inpatient Coder
Any certification not listed above but issued by one of the Governing Bodies (see below) will be reviewed and considered by the business as satisfying this requirement.
Minimum Skills/Specialized Training Required
- Expert of International Classification of Diseases, Tenth Revision, Clinical Modification ("ICD-10-CM"), International Classification, Tenth Revision, Procedure Coding System ("ICD-10-PCS"), Current Procedural Terminology ("CPT"), Healthcare Common Procedure Coding System ("HCPCS"), American Hospital Association ("AHA") coding clinic guidelines, Medicare Severity Diagnosis Related Groupers ("MSDRG"), All Patient Refined Diagnosis Related Groupers ("APRDRG"), Center for Medicare & Medicaid Services ("CMS") guidelines, National Center for Healthcare Statistics ("NCHS"), Radiation Oncology Coding Guidance (Coding Strategies, American Society for Radiation Oncology ("ASTRO"), American College of Radiation Oncology ("ACRO"), American Health Information Management Association ("AHIMA") and American Academy of Professional Coders ("AAPC") code of ethics.
- Ability to communicate in a professional manner to internal and external customers.
- Thorough understanding of the effect of data quality on prospective payment, utilization, and reimbursement for multiple medical specialties.
- Excellent communication and interpersonal skills.
- Experience with automated patient care and coding systems. (Cerner Electronic Health Record, Cerner products Radnet, Surginet, OPTUM Professional Computer Assisted Coding ("pCAC"), Patient Keeper, 3M encoder, Mosaiq, Soarian financial billing system, preferred.)
- Competence with MS Office software (Word, Excel, PowerPoint, OneNote, and Outlook).
- Experience with coding oncology-related services.
- Experience conducting training through Zoom
Preferred Experience
Four years' experience with coding oncology-related services.
Governing Body Website:
- American Health Information Mgmt Assoc (AHIMA) www.AHIMA.org
- American Academy of Professional Coders
https://www.aapc.com/certification/credential-verification.aspx