Essential Job Responsibilities:
- Lead training sessions on current billing and coding information in the medical field.
- Develop curriculum and training for newly hired providers; monitor coding clearances to meet TPR standard.
- Perform quality assurance reviews to assess comprehension of training efforts.
- Organize and participate in coding and billing meetings.
- Review and respond to coding questions from providers and staff.
- Research updated coding information, rules, laws and statutes, for all payers and government entities and proactively educate providers and staff.
Provide continual and as needed coding and payer specific education to providers and staff.
- Perform random chart audits for remote and onsite coders as well as providers.
- Ensure billed service is being accurately coded.
- Communicate findings of audits and prepare education as needed.
- Conduct coding reviews and training programs to assure coding quality.
- Perform analysis of benchmark to actual on coding related Key Performance Indicators
- Monitor coding holds and turnaround times for responses to payers and/or market finance teams.
- Monitor and track appeals
- Prepare unlisted procedures, as needed, per TPR SOP
- Research coding issues that arise from staff, providers or the organization.
- Work with coding vendor partners and manage the process within the market.
- Establish monthly meetings with vendor to review current work to SLAs
- Ensure vendor partner is informed of new hires
- Review any coding corrections and/or regulatory issues no less than monthly or sooner as needed.
- Maintain knowledge of ICD10 and CPT classifications and coding of diagnoses and procedures.
- Identify elements of a medical record's structure and content and code abstracting. Periodically reviewproviders coding vs the error rate of the coder assigned to the provider; move providers from coding review to independent provider coding and rotate provider to the audit schedule for all providers meeting established baseline.
- Participate in monthly TPR coding meetings with TPR coding educators and TPR Regional Coding Directors
- Work with Quality teams on EHR templates
- Work with Compliance teams as needed and manage any remediation plans for assigned providers and/or staff
Knowledge of all regulatory, compliance and third-party billing and collection guidelines and keeps abreast of any changes or any issues that might arise as well as communicating those changes/issues to senior leadership, team members and practice staff.