Position Summary

The Coding Consultant will review medical records, verify coding accuracy, and provide a summary of findings. Assist with presentation of educational information to Clients and Staff, through teamwork and communication, to ensure that education is inclusive of information needed to maintain or improve quality of coding and billing. Will work as a coding contact and resource for Billing Staff. The Coding Consultant will possess excellent communication and customer service skills while striving to maintain an efficient and productive office.

Key Objectives

• Abstracts clinical information from medical records and assigns the appropriate CPT and ICD-10 codes using industry-standard coding guidelines for various specialties
• Maintains up-to-date knowledge of coding and documentation requirements
• Responsible for sharing and presenting CPT, ICD-10 changes that take place
• Assist staff with coding questions
• Some medical billing duties
• Perform coding audits at client offices
  • Chart Audits
  • Billing reviews
  • Workflow analysis
  • On-Site Billing
• Educates client providers and staff on documentation & coding guidelines and changes to ensure compliance with state and federal regulations
• Provides measurable, actionable solutions to client providers that will result in improved accuracy for documentation and coding best practices
• Responsible for lead generation for consulting services
• Internal audits to present to compliance team
• Ability to travel within state to client locations
• Testify on any audit that go to litigation
• Ensure clients are assisted in a courteous and expedient manner
• Meet and exceed goals set forth through the annual performance evaluation process
• Growing use and knowledge of applicable company technology, paperless systems, tools and processes

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Qualifications

• Associates Degree, Business Administration or equivalent; or the combination of education and work experience that enables the performance of all aspects of the position is required
• AAPC Certified Professional Coder (CPC) REQUIRED
• Ability to code conditions and procedures using ICD-10-CM and CPT
• Knowledge of medical terminology and anatomy
• Knowledge of HMO/PPO, Medicare, Medicaid, and other payer requirements and systems
• Use of computer systems, software, 10 key calculator
• Effective communication abilities for phone contacts with insurance payers to resolve issues
• Customer service skills for interacting with patients regarding medical claims and payments, including communicating with patients and family members of diverse ages and backgrounds
• Able to work in a team environment.
• Problem-solving skills to research and resolve discrepancies, denials, appeals, collections.
• Knowledge of accounting and bookkeeping procedures.
• Strong communication and presentation skills
• Proven relationship building skills with clinical and non-clinical personnel

Preferred Qualifications

• Certified Professional Medical Auditor (CPMA) certification
• Actively pursue learning and development opportunities
• Participate actively in all on-the-job and formal learning and development opportunities to understand role and responsibilities
• Ability to accept and adjust to changing priorities and circumstances

Leadership

• Reports to direct supervisor
• Take charge and be action-oriented and persist until the task or job is completed
• Learn and understand how position is critical to the success of the organization and be willing to accept responsibility and be accountable for own actions

Technology

• Experience with Microsoft Office
• Medical Billing workflow software
• Understand and stay current on new technology