Coding Quality Specialist

Job Summary

Perform coding audits to determine that all coding and billing remains compliant and meets all federal and state guidelines (i.e. Medicare/ Medicaid). Assist in development, implementation and maintenance of provider and coder education. Serves as a subject matter expert for the department and a resource for the LMC enterprise.

Minimum Qualifications

Minimum Education: Bachelor’s Degree in Health Information, Business, or a Related Field
Minimum Years of Experience: 3 Years of Coding Experience
Substitutable Education & Experience (Optional): A Bachelor's Degree can be substituted for one of the following combinations:
High School Diploma with 3 Years of Additional Coding Experience;
Associate's Degree with 1 Year of Additional Coding Experience.
Required Certifications/Licensure: Must have one of the following: CPC, CPMA, COC, CCS-P, CCS, RHIA, RHIT or other specialty credential with Director approval
Required Training: Must have experience working with CPT, ICD diagnosis coding, E/M Documentation Guidelines (1995/1997/2021), CCI edits, Medicare LCDs and NCDs, state and federal regulations, as well as payor billing requirements;
Must be computer literate with experience using electronic health records software. Must have experience with Microsoft applications (i.e., Word, Excel, etc.).

Essential Functions

• Coordinates with Coding Managers and Director on audit assignments for all coding department staff, to include quarterly audits and focused audits as frequently as needed. Reviews overall coding quality for compliance to guidelines in order to validate billing assignments and resolve potential errors.
• Reviews coding of claims generated by LMC owned physicians and coders for adherence to established coding guidelines supported by adequate documentation.
• Fundamental part of supplementing the overall compliance process. Working closely with Corporate Compliance and Coding leadership, performs additional audits and staff education whenever a coding issue is found.
• As the primary auditor for initial reviews, will prepare or facilitate educational programs for both physicians and other coders regarding the best coding methodologies, to include information on new guidelines and important updates.
• In resolving coding compliance issues, works with leadership to thoroughly gauges improvement measures and ensure future resolution.
• Utilize chart audit software to analyze audit results, to include diagnosis, procedures, and modifiers.
• Reports results of audit findings to the Coding Quality Manager and Director of Coding.
• Directly educates coding department staff and physicians as requested, advising on appropriate coding and documentation techniques.

Duties & Responsibilities

• Works as a team with physicians, coding staff, and other personnel to ensure proper and accurate code assignment and continuous quality improvement.
• Identifies charge capture opportunities and assists with implementation of coding and billing processes.
• Works coding denials on a daily basis and communicates coding changes made to the appropriate coder.
• Assists in onboarding new employees to the department.
• Adheres to all policies.
• Must keep license or Coding Degree Current (Continuing education per approval of Director of Coding).
• In keeping with the LMC vision, treat patients, fellow employees, and all individuals met while representing Lexington Medical Center with courtesy and respect.
• Performs all other duties as assigned.