Certified Coder-Provider Education Specialist - Florida Community Health Centers, Inc.

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Position Control #

# 09-5027-342

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Location(s)

Position Summary: The Certified Coder, Provider Education Specialist, provides an essential role in supporting a team of medical clinicians to further their understanding of and compliance with medical coding standards. This individual will be responsible for monitoring medical coding trends, identifying areas of risk and improvement, regularly reporting trends to leadership, developing a training curriculum and training/testing materials, training clinicians in a variety of settings and methods, reporting training activities and measuring the impact of training. While this position does not have any staff reporting to it, it is expected that the Certified Coder, Provider Education Specialist will support the Certified Coder, Claims Analyst position, by offering ad hoc technical guidance.

ROLES AND RESPONSIBLITIES:

Develops a comprehensive training curriculum that includes: 1.) a medical coding “foundational” course for newly hired or newly licensed clinicians 2.) Medical coding “short courses” highlighting medical coding trends and suggestions for improving completeness and accuracy of documentation (one for the adult practice, one for pediatrics, and one for OB/GYN) 3.) Quarterly ICD‐10 updates. 4.) Medical coding fundamentals for patients with chronic conditions and enrolled in the ACO 4.) Targeted individual medical coding training.
Saves all training courses on LMS system, include training module quizzes to test clinician comprehension.
Collaborates with the Director, Business Intelligence, to develop system reports that highlight medical documentation and coding trends that will be utilized to establish training and reporting priorities.
Regularly meets with /observes clinicians to watch how they use the EMR and make recommendations for medical documentation and coding process improvements.
On a not less than quarterly basis, communicates medical coding training “workplan,” including training activities, key training objectives, challenges and accomplishments.
Conducts clinical orientation training on a by‐weekly basis to welcome incoming clinicians.
Work with center leadership to identify possible opportunities for front office operations to support clinicians in various aspects of coding
With assistance from the Billing and Coding Administrator, prepares and presents medical documentation and coding briefings to senior leadership.
Attends seminars and in‐services as required to remain current on coding issues.
Participate monthly Certified Coder team meetings submit recommended agenda items to the Billing and Coding Administrator.

SECONDARY ROLES AND RESPONSIBLITIES:

THE CERTIFIED CODER, PROVIDER EDUCATION SPECIALIST, MUST BE WILLING TO ASSIST OTHER MEMBERS OF THE CODING TEAM WITH THE FOLLOWING:

Audit records to ensure proper submission of services prior to billing on pre‐determined selected charges and track errors in the Coding Department folder on the X drive‐Coding Department‐Audits‐ Daily Claims Audits ‐ “Name here”.
Creates spreadsheets to track coding errors and corrections in the Coding Department folder on the X Drive‐Coding Department‐Audits‐ Daily Claims Audits‐ Provider Error Reports‐20XX.
Audit medical records to ensure proper coding is complete and concise as well as to ensure compliance with federal and state regulatory bodies.
Effectively communicate/correct and apply ICD‐10‐CM, CPT and HCPCS codes on claims.
Accurately follows coding guidelines and legal requirements to ensure compliance with federal and state regulatory bodies.
Analyzes provider documentation to assure the appropriate, ICD‐10‐CM, CPT, HCPCs, HEDIS and Evaluation & Management (E&M) codes are assigned using the correct codes
Review claims and charts with chronic conditions for possible errors in coding and the need for any Risk Adjustment corrections and build training based on findings for all responsible staff.
Set goals for performance and deadlines with Coding and Revenue Cycle staff in ways that comply with company’s plans and vision and communicate them to subordinates.
Partner in CQM, UR and ACO Meetings for needed expertise.
Assist with UDS, ACO, MCHS and Perinatal reports.
Submit agenda items to the Billing and Coding Administrator for all monthly coding team meetings.
Perform other related duties as required or assigned by the Billing and Coding Administrator.

QUALIFICATIONS AND EDUCATION REQUIREMENTS:

Associates Degree in management or equivalent experience preferred.
Four (4) years’ experience using ICD‐10‐CM, CPT, HCPCs, or its equivalency.
Medical Coding Certificate ‐ CPC, CCS‐P or RHIT certification is required.
Must have excellent interpersonal skills and is able to communicate effectively.
Must be proficient in: Microsoft Excel, Word and PowerPoint.
Must be able to review, and interpret medical records with minimum assistance from providers.
Must be able to analyze data and report it effectively.
Must have working knowledge of medical terminology and anatomy.
Must have knowledge of HCC and Risk Adjustment scoring.
Must have OB/GYN Coding and Billing knowledge.
Must be able to communicate and train effectively.
Must be able to travel to Centers when required.
Lean Six Sigma Green Belt or Higher preferred

ADDITIONAL NOTES:

THIS JOB DESCRIPTION IS NOT INTENDED TO BE ALL‐INCLUSIVE, AND EMPLOYEE WILL ALSO PERFORM OTHER REASONABLE RELATED BUSINESS DUTIES AS ASSIGNED BY SUPERVISOR.

*This organization reserves the right to revise or change job duties and responsibilities as the need arises. This job description does not constitute a written or implied contract of employment.