Job Description

TITLE: PB Coding Analyst and Educator

LOCATION: Mount Pleasant, TX (One Week a Month Onsite)

SCHEDULE: Full Time, Exempt

TYPE: Direct Hire

PAY: $27-45/Hr., Dependent on years of experience

JOB SUMMARY:

The PB Coding Analyst and Educator plays a critical role in ensuring compliant, accurate coding practices while fostering continuous education and collaboration between physicians, providers, and coding staff. The role requires expertise in medical coding, analytical skills to assess coding accuracy, and the ability to develop and deliver educational programs. The Analyst is responsible for reviewing coded accounts, identifying improvements, and ensuring synergy between clinical documentation, coding, and providers. The analyst would assist with enhancing provider workflows including input regarding EPIC templates.

RESPONSIBILITIES:

• Conducts comprehensive reviews of professional billing (PB) coded accounts. Evaluate the accuracy and completeness of assigned ICD-10-CM, CPT, and modifiers based on physician documentation and medical records.
• Audits medical records to evaluate provider and coder performance. Additionally, identify errors, inconsistencies, and missed opportunities for capturing additional diagnoses and procedures.
• Analyzes trends in coding practices and identify areas needing improvement or further education. Partners with departments and providers to make improvements in overall performance, quality, and accuracy.
• Collaborates with clinicians and coders to resolve discrepancies and ensure accurate code application.
• Identifies knowledge gaps and specific training needs through coding analysis findings and by pulling information from industry resources such as AAPC, AHIMA, and CMS guidelines.
• Designs curriculum materials addressing current coding guidelines, industry best practices, and emerging trends in healthcare coding and documentation. Determine which resources are needed to apply knowledge (tip sheets, workflows, policies, work queues, process documents, etc).
• Utilizes a variety of teaching methods, including in-person and online sessions, interactive workshops, and e-learning modules, catering to different learning styles and professional levels.
• Delivers engaging and informative training sessions aimed at enhancing coding accuracy, efficiency, and compliance.
• Monitors industry publications, websites and participate in relevant coding associations to stay informed of updates in coding regulations and guidelines.
• Analyzes the impact of new coding rules and regulations on internal practices and incorporate these changes into training and coding procedures by ensuring quarterly and annual code updates are implemented and educated on.
• Ensures that both coding systems and staff remain updated on coding changes, promoting compliance with CMS, other governing bodies, and payers.
• Stays abreast of regulatory updates and industry standards to ensure all practices are in line with federal and state guidelines, including adherence to CMS mandates.
• Analyzes internal and external data to identify trends, potential issues, and areas for improvement.
• Collaborates with IT and revenue cycle management teams to optimize coding, documentation, and CDM management systems.
• Manages technical upgrades, ensuring seamless implementation of new modules or system enhancements including provider templates.
• Other duties and responsibilities as assigned

SKILLS REQUIRED:

• Strong knowledge of medical terminology, disease classification, and healthcare coding systems (ICD-10-CM, CPT, HCPCS).
• Proficiency with healthcare coding software, including CAC and EPIC.
• Strong analytical and problem-solving skills.
• Excellent communication and interpersonal skills to foster collaboration across teams.
• Knowledge of CMS regulations and industry-based standards

WORK EXPERIENCE REQUIRED:

• Minimum 3 years of experience in professional medical coding, with experience in coding analysis or auditing preferred.
• Extensive knowledge of ICD-10-CM, CPT, and HCPCS coding guidelines and conventions.
• Demonstrated experience in developing and delivering educational programs for healthcare professionals.
• Knowledge of 3M and EPIC systems.
• Experience conducting audits and implementing quality assurance initiatives

EDUCATION/CERTIFICATIONS REQUIRED:

• Associate’s degree in Health Information Management, medical coding, or a related field preferred.
• Coding certificate with 3 years of coding experience in a physician office, group practice, multi-specialty clinic or specialty center in lieu of associate’s degree.
• Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Professional Coder (CPC), Certified Coding Specialist-Physician based (CCS-P), or equivalent certification (required), with CPMA preferred.
• Additional coding certifications from AHIMA or AAPC are a plus.
• EPIC Certification such as PB Revenue Integrity: Charge Capture and Coding is a plus

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