Tufts Medical Center
Reporting to the coding manager, this position manages the CPT and ICD-9 coding and audit functions, and develops and administers a comprehensive coding education program for all Tufts MC PO physicians and administrative staff. Ensures compliance with all third party coding and documentation requirements. Audits charge documents and remittances (and/or ad-hoc reports) to ensure reimbursement maximization as it relates to CPT and ICD-9 coding. Acts as the primary coding expert and resource to P.O. staff and Reimbursement/Coding staff.
Acts as the primary coding expert/resource for all TUFTS MC P.O. physicians, their billing staff and Reimbursement Department staff. Develops and administers a detailed, comprehensive education program to ensure physician compliance with third party Evaluation & Management (E & M) documentation requirements. Educates Coding Physician Liaison staff in fundamental E & M documentation guidelines. Monitors all third party coding-related correspondence and specialty related coding newsletters to ensure Tufts MC P.O. physicians remain current on all CPT and ICD-9 coding development. Assesses coding training needs of the physicians. Conducts training sessions on all aspects of proper coding and documentation for all physicians. Develops audit methodology and conducts coding audits. Performs medical records documentation audits for purpose of maximizing E & M reimbursement. Works closely with Physician Liaisons to quantify reimbursement impact of findings. Develops reports to communicate audit results effectively. In conjunction with liaison staff, reviews payment data on a regular basis. Suggests coding process improvements for optimal coding and reimbursement. Reviews CPT and ICD-9 coding relationships and reports findings to physicians. Contacts physicians to discuss denials and to obtain additional documentation as required. Develops clinical appeal letters for submission to third parties and works with physicians and Liaison staff to pursue additional reimbursement with third parties.
CPC, or RRA or ART certification required. Must maintain membership in appropriate professional associations. Minimum of two to five years professional coding experience, preferably in a consulting firm or large multi-specialty practice. Prior clinical experience preferred. Strong computer skills and familiarity with Microsoft Word, Excel preferred. Knowledge of IDX billing system desired. Strong management and interpersonal skills. Excellent written and oral presentation skills. Must be comfortable making presentations to physicians. Ability to work independently. Reports to the manager of coding. Frequent interaction with TUFTS MC P.O. Reimbursement Department staff. Frequent interaction with TUFTS MC P.O. physicians and their billing staff. Normal office working conditions. Must be able to perform all essential functions of this position with reasonable accommodation if disabled.