Coding Compliance Specialist jobs in North Carolina

Position Summary

The Provider Educator & Auditor is responsible for creating and delivering highly engaging training for FastMed providers regarding coding and documentation. They will review Physician and Advanced Practitioner documentation and selection of Current Procedural Terminology (CPT), International Statistical Classification of Diseases and Related Health Problems (ICD-10), Healthcare Common Procedure Coding System (HCPCS) codes and modifiers to FastMed services provided. The Provider Educator & Auditor will summarize the findings of these reviews and provide training tailored to the findings including review of examples, illustration of correct coding and references to relevant coding guidelines. The Provider Educator & Auditor applies and follows ICD-10-CM, CPT and all appropriate government coding guidelines, adhering to all FM coding/billing policies and procedures while engaging with physicians, Advanced Practitioners and staff with any coding questions and concerns.

Duties and Responsibilities

1. Analyze office encounter documentation, procedural and operative records to identify and independently assess the accuracy of ICD and CPT/HCPCS codes based upon ICD-10-CM, CPT and all appropriate government coding guidelines, in addition to adhering to all FM coding/billing policies and procedures.
   1. Effectively utilize coding tools and related materials to investigate coding accuracy and produce accurate results.
   2. Maintains compliance with Federal, State and Payer regulations.
   3. Identify opportunities for providers to enhance documentation to fully reflect services delivered and capture the full range of medical decision making conducted.
2. Provide regular coding education to providers to ensure accurate, compliant coding practices.
   1. Create standardized training materials and training plan for Evaluation & Management codes and documentation.
   2. Review individual provider documentation and claim examples to identify areas of potential improvement. Incorporate these findings into documentation and training tailored to specific specialties or provider needs. Create reports summarizing findings. 
   3. Deliver training in person and/or via virtual meetings, track training delivery and record attendance. 
   4. Respond to training follow up questions and conduct follow up training as needed. 
   5. Communicate coding and regulation changes to providers.
   6. Serves as a resource to providers and clinical staff on coding questions and documentation requirements/guidelines and provides feedback as needed.
   7. Review additional documentation examples following education to determine the impact of education. 

Experience, Skills, Education and/and Certification/Licensure

License / Registration / Certification

Must be certified in at least 1 of the following: Certified Professional Coder (CPC), Registered Health Information Administration (RHIA), Registered Health Information Technologist (RHIT), or Certified Coding Specialist (CCS).

Issued by (Governing Body)

AAPC, AHIMA or Accredited Program

Level of Education

High School diploma or general education degree (GED) required. 

Associate degree preferred, or 2 years experience equivalent

Field of Study   N/A

Years of Experience

Minimum of 2 - 5 years experience in healthcare coding and billing 

Describe Type of Experience

• Professional coding and billing
• Experience in multi-specialty physician coding or expert in single specialty physician coding required.
• Epic experience highly preferred.

Minimum knowledge, skills and abilities:

• Excellent communication skills required. 
• EPIC software preferred or familiar with other EMR software required.        
• Strong working knowledge of physician coding rules and guidelines
• Knowledge of insurance guidelines to maximize coding reimbursement
• Ability to interpret, analyze, and abstract data/documentation
• Detail oriented, initiative taking individual with good problem-solving skills, effective communication skills, and positive attitude
• Ability to adapt to continuously changing environment

Physical Demands

The physical demands and work environment characteristics described here are representative of those that must be met by a team member to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While working the essential functions of this job, the employee is occasionally required to stand, walk, sit, life, carry, use hands to handle or feel objects, tools or controls, reach with hands and arms, climb stairs, balance, stoop, kneel, crouch or crawl, talk, hear and lift and/or move up to 40 pounds. 

Work Environment:

While performing the essential functions of the job the employee may be in the office or work remotely dependent upon the company and/or department’s policies.

Managerial Demands:

N/A

Reporting to This Position:

N/A

General Sign Off

The team member is expected to adhere to all company policies and act as a role model in so doing as well as provide outstanding customer service.  The information contained in this job description is not intended to be exhaustive. FastMed reserves the right to revise and amend job descriptions at any time.