Advocate Health Care

Department:

10417 Enterprise Revenue Cycle - Coding & HIM Support Professional

Status:

Full time

Benefits Eligible:

Yes

Hours Per Week:

40

Schedule Details/Additional Information:

Fully Remote

Major Responsibilities:

• Review assigned codes, which most accurately describe each documented diagnosis and/ or procedure according to established CPT, HCPCS, and ICD-10-CM coding guidelines along with modifier usage and medical terminology. Monitor all coding accuracy at various levels of detail and maintain coding quality as needed. Track coding issues and review coding inaccuracies to highlight areas of improvement. Report or resolve escalated issues as necessary.
• Responsible for reviewing Clinician documentation and billed codes for Medical Group physicians and non-physician clinicians. Review of medical records in collaboration with key stakeholders such as Internal Audit, Compliance, and Clinic Operations. Responsible for completing all certified coder quality reviews. Working in collaboration with Coding Production Leads and Supervisors.
• Follows the prospective and/or retrospective review plan to sample employed Clinician's medical record documentation in comparison to services selected for billing, based on best practice methodologies which will be presented and reviewed with Clinicians to provide feedback on proper coding and documentation practices.
• Follows the necessary schedules for team assignments of documentation/coding accuracy. Conducts required, timely reviews per the established Clinician Documentation Review Plan and generates summary reports for Professional Coding leadership and Provider Compliance Committee. Develops mechanisms to identify specific quality issues for each Clinician to allow for focused follow-up reviews to identify improvement/correction of those elements for which the Clinician has received an education.
• Ensures compliance with the system Clinician Documentation Review Plan escalation process for any Clinician who is not successful in meeting the minimum acceptable thresholds. Provides feedback when documentation issues are identified that need improvement. Conducts focused reviews requested by the Compliance department, clinic administration, and Professional Coding leadership. Utilizes monitoring tools or other applications to track and report the progress of the Clinician Documentation & Coding Accuracy Plan and for the evaluation of coding quality standards.
• Identifies, evaluates and acts to resolve any barriers to meeting documentation standards. Provides education/feedback to the department Educators and Coding Liaisons. Maintains coding quality standardized reporting mechanisms. Provides standardized statistical reports of coding quality information to Professional Coding leadership and other appropriate parties.
• Identifies and trends coding quality issues/concerns. Recommends coding accuracy improvement strategies, including continued education and/or training plans. Provides feedback regarding coding guidelines, coding protocols/procedures, and system edits to continually improve coding processes and ultimately the overall coding quality program.
• Conducts scheduled and ad hoc coding quality reviews. Conducts regularly scheduled reviews of encounters where coding has been changed or deleted by Coding team members to ensure accuracy and provide education recommendations. Reviews abstracted and coded encounters for coding accuracy and completeness. Provides feedback on billing system edits as applicable.
• Provides results to Physician Coding leadership and education recommendations as needed. Collaborates with interdepartmental or cross-functional teams for assigned projects and provides departments with coding issues and updates to be shared with Clinicians.
• Utilizes chart review results to provide data-driven feedback to clinicians and management to improve coding accuracy and identify opportunities for improvement and re-training. Maintains up-to-date knowledge of Medicare, Medicaid, and other regulatory requirements pertaining to nationally accepted coding policies and standards.

Licensure, Registration, and/or Certification Required:

• Coding Associate (CCA) certification issued by the American Health Information Management Association (AHIMA), or
• Coding Specialist - Physician (CCS-P) certification issued by the American Health Information Management Association (AHIMA), or
• Health Information Administrator (RHIA) registration issued by the American Health Information Management Association (AHIMA), or
• Health Information Technician (RHIT) registration issued by the American Health Information Management Association (AHIMA), or
• Professional Coder (CPC) certification issued by the American Academy of Professional Coders (AAPC), or
• Specialty Coding Professional (SCP) certification issued by the Board of Medical Specialty Coding and Compliance (BMSC), and
• Specialty Medical Coding Certification issued by the American Academy of Professional Coders (AAPC).

Education Required:

• Advanced training beyond High School that includes the completion of an accredited or approved program in Medical Coding Specialist.

Experience Required:

• Typically requires 5 years of experience in expert-level professional coding and at least 3 years of experience in the education of clinicians in physician revenue cycle processes, health information workflows, and medical record auditing experience.

Knowledge, Skills & Abilities Required:

• Advanced knowledge of ICD, CPT, and HCPCS coding guidelines.
• Advanced knowledge of medical terminology, anatomy, and physiology.
• Advanced ability to identify coding quality issues/concerns and provide recommendations for improvement.
• Advanced ability to analyze trends and data and display them in a statistical reporting format.
• Advanced organization and communication (verbal and written) skills.
• Advanced ability to effectively train others through oral and/or written methods.
• Advanced organization, prioritization, and reading comprehension skills.
• Advanced analytical skills, with high attention to detail.
• Intermediate computer skills including the use of Microsoft Office, email, and exposure or experience with electronic coding systems or applications.
• Advanced knowledge of care delivery documentation systems and related medical record documents.
• Advanced interpersonal communication skills (oral and written) necessary to collaborate with Physicians, other clinicians, and Professional Coding Department team members and leadership.
• Ability to work independently and exercise independent judgment and decision-making.
• Ability to meet deadlines while working in a fast-paced environment.
• Ability to take initiative and work collaboratively with others.

Physical Requirements and Working Conditions:

• Exposed to normal office environment.
• Position requires travel which will result in exposure to road and weather hazards.
• Operates all equipment necessary to perform the job.

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.

#LI -Coding

#LI -Remote

Pay Range

$26.10 - $39.15

Our Commitment to You:

Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more – so you can live fully at and away from work, including:

Compensation

• Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training
• Premium pay such as shift, on call, and more based on a teammate's job
• Incentive pay for select positions
• Opportunity for annual increases based on performance

Benefits and more

• Paid Time Off programs
• Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
• Flexible Spending Accounts for eligible health care and dependent care expenses
• Family benefits such as adoption assistance and paid parental leave
• Defined contribution retirement plans with employer match and other financial wellness programs
• Educational Assistance Program

About Advocate Health

Advocate Health is the third-largest nonprofit, integrated health system in the United States, created from the combination of Advocate Aurora Health and Atrium Health. Providing care under the names Advocate Health Care in Illinois; Atrium Health in the Carolinas, Georgia and Alabama; and Aurora Health Care in Wisconsin, Advocate Health is a national leader in clinical innovation, health outcomes, consumer experience and value-based care. Headquartered in Charlotte, North Carolina, Advocate Health services nearly 6 million patients and is engaged in hundreds of clinical trials and research studies, with Wake Forest University School of Medicine serving as the academic core of the enterprise. It is nationally recognized for its expertise in cardiology, neurosciences, oncology, pediatrics and rehabilitation, as well as organ transplants, burn treatments and specialized musculoskeletal programs. Advocate Health employs 155,000 teammates across 69 hospitals and over 1,000 care locations, and offers one of the nation’s largest graduate medical education programs with over 2,000 residents and fellows across more than 200 programs. Committed to providing equitable care for all, Advocate Health provides more than $6 billion in annual community benefits.