Coding & Documentation Specialist, EMR Lead - Orthopedic One

• POSITION SUMMARY
  • Educates new providers and provides updates regarding coding, documentation, MIPS and EMR related tasks relevant to Therapy Services. Review and assign diagnosis and procedure codes after review of medical documentation for both internal and external purposes. Assist and train therapy staff in EMR related tasks including; templates, schedules and work flows.
• RESPONSIBILITIES AND ACCOUNTABILITIES
  • Orthopedic Coding:
    • Review therapy notes for billable providers prior to releasing note to Patient Accounts department for:
      • Presence of physician order and/or referral
      • Documentation of prior authorization
      • Quality and accuracy of note
      • 8 minute rule compliance
      • CPT code assignment
      • ICD-10 coding and sequence
    • Generate reports and follows up as needed on unsigned progress notes by therapy providers and physicians
    • Provide feedback to Therapy Services leadership regarding documentation quality
    • Prepare and organizes documentation in response to carrier audits, denials and take backs.
    • Handle confidential information regarding patient records with knowledge of release of information policies.
    • Contact billable providers to clarify documentation and conventions in order to provide detailed coding information.
    • Assist interdepartmental and intra-departmental associates on coding practices and conventions in order to provide detailed coding information.
    • Participate in the development of coding policies and procedures as identified.
    • Maintain a cohesive working relationship with staff and management (inter and intra-departmental) and working as a team to achieve optimal efficiency.
    • Communicates directly with billable providers to ensure that clinical documentation is coded timely, accurately, and in compliance with CMS guidelines and national coding initiatives.
    • Identify and clarify missing, conflicting, or nonspecific clinician documentation related to diagnosis and procedures.
    • Review coding denials from payers and recommend appropriate action to resolve the claim based on payer guidelines.
    • Serve as a resource to Patient Accounts leadership when needed for orthopedic specific coding, denials, and other tasks associated with claim payment
  • Electronic Medical Record (EMR) Lead
    • Develop EMR training manual for therapy and conducts training based on departmental/individual needs
    • Perform chart reviews under the supervision of department leadership.
    • Identify inefficiencies and non-compliant documentation and work flow trends during chart reviews.
    • Assist with staff education when issues of non-compliance have been identified and follows up to ensure resolution.
    • Assist with designing new templates and making changes to schedules.
    • Maintain short hand library and ensures it is up to date on the network drive.
    • Conduct presentations and group education as needed for any major changes or updates in EMR, MIPS and other related work.
    • Address process improvement and work flow review with the goal of improving documentation and decreasing provider time in completion of documentation.
    • Proactive management of billing related messaging to provider with the goal of identifying trends effecting claims payment and decreasing provider distractions from patient care.
• TEAMWORK
  • Teamwork:
    • Willingly provides coverage, volunteers assistance, and maintains workflows within department as needed without direct instruction/supervision.
    • Works cooperatively and refrains from participating in negative conversations.
    • Shares knowledge and insights with co-workers in a constructive manner.
    • Works to solve problems and address conflicts with appropriate person directly before involving leadership or uninvolved peers.
    • Is considerate of others in the work environment with regard to taking breaks or meal periods, use of computer and phone, noise level in the department, etc.
• POLICIES AND PROCEDURES
  • Policies and Procedures
    • Knows and complies with policies and procedures as enumerated in the Orthopedic One Employee Handbook and policies and procedures documents.
    • Provides assistance and support to leadership in implementing policies and procedures as necessary.
    • Actively participates in training, and conducting day to day work activity by adhering to all policies and procedures as enumerated in compliance and risk management programs.
• QUALIFICATIONS
  • Education, Experience, Certification and Licensure Requirements:
    • High School Diploma or equivalent required. Previous medical billing experience, preferably in an orthopedic surgery specialty is required. Candidates must have current certification as a Certified Professional Coder or equivalent. Proficiency with software including practice management systems and Microsoft Excel.

PI250290544