Anesthesia Coding Quality Reviewer/Educator

US
Job ID
2017-1545
Function
Revenue Cycle Management
Employment Status
Full-Time

Overview

The individual in this role will support our QA process. Responsibilities include the reviewing of pro-fee coding accuracy and quality and involvement with the coders in which they personally QA. The function of this role supports, but is not limited to, coders, team leads, supervisors and operations managers.  Assist in trainings and provider education if needed.

Responsibilities

The position requires strong communication and analytical skills as well as the ability to work independently while meeting required due dates.

  • Retrospective and Prospective Coding QA Reviews
  • Complete all quarterly, monthly or project based QAs on assigned coders in a timely manner.
  • New Coder Pre-production QA and support
  • Complete tracking workbooks with feedback to be turned in timely as per P&P.
  • Attain and ensure defined green zone accuracy from coders being reviewed for CPT/ICD-10.
  • Report and escalate outliers as defined in the coding QA P&P
  • Provide detailed findings for educational opportunities in collaboration with assigned Educators.
  • Assists with the development of coding educational materials and training for use both internal and external to the department, including physicians
  • Identify clinical documentation insufficiencies that impact code assignments
  • Identify and escalate inconsistent or unclear internal workflow or pathway directives that impact code assignments or services.

Training

  • Assists in the development and delivery of specialty Training and coding updates
  • Assists in the new coder or vendor training on platforms or coding nuances.
  • Assists with creating or updating the coding policies and procedures and site/location pathways
  • Prospective Review Pended Items
  • May be asked to assist with review and feedback of pended cases or inquiries.

Other Job responsibilities, see below

  • Assist in supporting teams with analysis and review of documentation for new business
  • Maintains confidentiality of sensitive information concerning patients, physicians, employees, clients, vendors, and the company
  • Ensure compliance with all State, Federal, professional regulations as well as department rules, policies, and procedural manual
  • Adherence to Safety Regulation
  • Adherence to HIPAA Regulation
  • Maintain specialty certification CEU’s, coding updates and all regulatory or payer guidance
  • Other duties as assigned

Qualifications

The individual in this role must possess a coding certification and have compliance auditing experience (CPC or CCS)

  • National Certification or Minimum of five years’ Experience in Anesthesia Coding, Pain
  • Management and E/M
  • Experience in MS Office including Excel Word and Power Point
  • Experience in Revenue Cycle and Claim denial review
  • Experience in various billing and EMR systems (ie GE, Epic)
  • Ability to work independently in remote environment
  • 25% Travel may be required

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