GENERAL SUMMARY:Under the direction of the BMG Shared Services Senior Director, and Senior Director Compliance , this position provides expertise and provider educational feedback regarding coding and documentation for those areas under BMG for professional coding. Responsible for ensuring integrity in accordance with regulatory risk areas for professional provider practices. Includes providing expertise in CPT4, ICD10 coding guidelines, Medicare Teaching guidelines, additional payer regulations, and policies for professional and facility services . Provides educational programs for physicians, and others as required. Reviews and make recommendations of new CPT4 and ICD-10 codes and provides recommendations for physician practices annual encounter review.
ESSENTIAL DUTIES:
- Provides quality assurance monitoring feedback for compliance with third party regulations, teaching physician coding and documentation requirements with educational feedback directly to providers. Assists providers in developing the content for complete, timely and accurate documentation format for appropriate billing/coding practices.
- Prepares and presents regular formal and informal education sessions for providers as required
- Communicates with providers, leadership team, billing department and Information Services regarding facility and professional billing and coding for the purpose of timely problem solving and quality improvement.
- Provides support to providers regarding utilizing appropriate payer methodologies and modifiers as necessary.
- Assists providers in review of updates, development of coding tools and guidelines including Patient Encounter Record.
STANDARD QUALIFICATIONS
- Bachelor's degree required or equivalent education and work experience. (E.g. Associate degree 5-7 year's relevant experience).
- Minimum 5 years professional healthcare experience required (e.g coding). Previous audit experinece preferred. Knowledge of billing processes preferred. Comprehensive knowledge of coding for OP and E/M required. Experience with Multi-Specialties.
- Certification:
Other Qualifications:
