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Overview

The Professional Coding Compliance Specialist provides revenue cycle support to Riverside Medical Group and its coding team by regularly auditing provider documentation and corresponding coding to ensure correct, complete and compliant practices that fully support diagnoses reported and charges submitted for services rendered, meet regulatory and payor-specific requirements, and accurately describe the patient encounter; providing feedback and education to providers and coders based on audit results, regulatory changes, and industry trends; assisting with orientation of new providers, residents/fellows, and new members of the coding team.

Essential Duties

- Completes timely audits of assigned providers and coders for accurate, complete, and compliant ICD-10-CM and CPT/HCPCS code assignment, ensuring that documentation supports the diagnoses reported, E/M level selected, and CPT/HCPCS codes submitted for services rendered during the episodes of care reviewed
- Reviews audit findings with assigned providers and coders, providing real-time education on opportunities identified and offering objective supporting documentation (e.g., current coding conventions, regulatory/payor-specific requirements, risk-adjustment guidelines, organization-specific policies) to support findings and use as reference
- Documents audit results in designated Excel log as soon as review is completed
- Immediately reports adverse audit trends, potential areas of risk, and compliance concerns to management
- Assists coding compliance lead in creating and publishing monthly provider newsletter
- Collaborates with coding compliance team and provider-focused coding manager to develop and maintain current coding guidelines for Riverside Medical Group as a whole and its specialists to ensure compliance and consistency across practices and their assigned coding teams
- Participates in developing and presenting provider and coder education programs as requested
- Assists coding compliance lead in maintaining orientation materials for new providers, residents, and fellows that reflect current coding and documentation rules and requirements
- Assists provider-focused coding manager and coding compliance lead in orienting and educating new team members as requested
- Serves as coding compliance resource to Riverside Medical Group and Riverside Medical Center as requested
- Assists in provider-focused coding and charge entry as needed to meet fiscal deadlines and backfill staff vacancies

Responsibilities

Required Experience

- Minimum three years current ICD-10-CM and CPT/HCPCS (including E/M assignment) coding experience in a multi-specialty medical practice or comparable coding experience required

Required Licensure/Education

- High school graduate or equivalent required.
- AAPC/CPC (Certified Professional Coder) required
- AAPC/CPMA (Certified Professional Medical Auditor) strongly recommended at hire; required within two years of hire
- AAPC/CRC (Certified Risk-Adjustment Coder) strongly recommended

Preferred Education

- Associate degree in health-related field preferred
- Formal education in ICD-10-CM and CPT/HCPCS coding principles and assignment maintained by relevant continuing education

Employee Health Requirements

Exposure/Sensory Requirements:

Exposure To

- Chemicals: NA
- Video Display Terminals: Average
- Blood and Body Fluids: None
- TB or Airborne Pathogens: None

Sensory Requirements (speech, Vision, Smell, Hearing, Touch)

- Speech: Needed for presentations/training, telephone communication, facilitate meetings.
- Vision: Needed to read computer screens and printouts, memos, communications, documentation, and literature.
- Smell: Electrical/fire safety.
- Hearing: Needed for telephone communications, meetings, and equipment operating characteristics.
- Touch: Needed to write, do computer entry, filing.

Activity/Lifting Requirements

Percentage of time during the normal workday the employee is required to:
- Sit: 55%
- Twist: 0%
- Stand: 20%
- Crawl: 0%
- Walk: 20%
- Kneel: 0%
- Lift: 0%
- Drive: 0%
- Squat: 0%
- Climb: 0%
- Bend: 5%
- Reach above shoulders: 0%

The weight required to be lifted each normal workday according to the continuum described below:
- Up to 10 lbs: Frequently
- Up to 20 lbs: Occasionally
- Up to 35 lbs: Occasionally
- Up to 60 lbs: Occasionally
- Up to 75 lbs: Not Required
- Up to 100 lbs: Not Required
- Over 100 lbs: Not Required

Describe and explain the lifting and carrying requirements. (Example: the distance material is carried; how high material is lifted, etc.):
- Putting away supplies.
- Lift above the head occasionally to place boxes on high storage shelves.
- Carry boxes up and down the stairs - distances up to 100 feet.

Maximum consecutive time (minutes) during the normal workday for each activity:
- Sit: 30
- Twist: .5
- Stand: 30
- Crawl: 0
- Walk: 2
- Kneel: 0
- Lift: 5
- Drive: 30
- Squat: 1
- Climb: .5
- Bend: .5
- Reach above shoulders: .5

Repetitive Use Of Hands (Frequency Indicated)

- Simple grasp up to 15 lbs.
- Normal weight: continuous
- Pushing & pulling Normal weight: 50-200#
- Fine Manipulation: Computer Keyboard and mouse.
- Repetitive use of foot or feet in operating machine control: Not Required

Environmental Factors & Special Hazards

- Environmental Factors (Time Spent):
+ Inside hours: 8.0
+ Outside hours: 0
- Temperature: Normal Range
- Lighting: Average
- Noise levels: Average
- Humidity: Normal
- Atmosphere:
- Special Hazards:
- Protective Clothing Required: Gloves when handling blood and body fluids.

Pay Range

USD $28.83 - USD $37.13 /Hr