Job Description

MISSION  

Integrative Emergency Services, LLC (“IES”), is dedicated to cultivating best practices in emergency care, providing comprehensive acute care services, creating value, and supporting patients, employees, clients, providers, and physicians in pursuit of the highest quality health care. 

POSITION SUMMARY  

This position will oversee and implement a coding review and education program.  The role will require a detailed approach and curriculum knowledge application in provider coding review, an understanding of current rules/guidelines/best practices, and an ability to effectively communicate with all stakeholders.  The success of this role will be defined by the individual’s ability to understand the current performance of provider coding, identify opportunities for improvement and education, and consistently drive performance.   

ESSENTIAL DUTIES AND RESPONSIBILITIES  

• Ensures regulatory compliance by remaining up to date with federal and state coding regulations, explaining them concisely to departmental heads and/or HIM/coding staff members, and checking that any necessary changes to existing processes have been made and instituted as standard practice 

• Correctly outlines organizational and departmental standards and expectations for new or existing service lines throughout the training process, in addition to providing a strong knowledge base to assist them in the acquirement of position-related skills throughout their term of employment 

• Develops and facilitates educational programming for providers of all levels, while simultaneously motivating them to retain a high degree of accuracy in all their respective job functions 

• Using clinical expertise, investigates and resolves charging and coding questions raised by the business services department and/or clinical personnel, including assessment of appropriate modifiers, the accuracy of services billed, completeness of coding, the applicability of Medicare regulations for CCI edits, etc. 

• Conducts monthly coding and documentation audits for accuracy and compliance, and uses them to identify trends or variances in coding that require additional training to correct and eliminate 

• Stays current on any regulation, best practices, or processes related to the implementation of CPTs and passes this knowledge down to all affected staff members 

• Organizes and/or assists in all CPTs related initiatives or teams and also formulates CPT specific training to ensure as smooth a transition as possible to the new code set

SUPERVISORY RESPONSIBILITIES 

This position carries out supervisory responsibilities in accordance with guidelines, policies and procedures and applicable laws. Supervisory responsibilities include interviewing, hiring, and training employees; planning, assigning and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems. 

Direct Reports (titles):  N/A 

Indirect Reports (titles):  N/A 

JOB REQUIREMENTS/SPECIFICATIONS 

EDUCATION AND EXPERIENCE: _ The requirements listed below are representative of the knowledge, skill, and/or ability required. _

REQUIRED: 

• Minimum three to five years of Emergency Medicine coding expertise required 

• Expertise in Medicare/Medicaid and all coding-related CMS guidelines, as well as a comprehensive understanding of MS-DRG, APR-DRG, and APC reimbursement systems 

• CPMA, CEMC, CPC-I or CCS-P or equivalent certification or related, relevant experience.  If not certified at hire, must attain relevant certification within twelve months of employment.

PREFERRED: 

• Current LPN or RN license 

• CPC, CCS-P, RHIA, or RHIT certification  

• Bachelor’s degree in related field  

• Experience in lead or supervisory role  

• Experience performing, analyzing, and providing feedback on physician documentation and coding audits

ESSENTIAL QUALIFICATIONS:   To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required.  

• Capable of working both in a team and individual environment, and confident working with a wide variety of healthcare professionals 

• High-level thinker with the ability to analyze complicated materials, such as coding and documentation audits, and place in a format all knowledge levels can easily understand 

• Strong communication skills, both written and oral 

• Ability to gauge knowledge and instruct individuals accordingly, with an emphasis on personalized education 

• Capable of coding across several specialties and varying degrees of complexity in CPT-4, ICD-9-CM, HCPCs, and ICD-10-CM systems with 90% percent accuracy 

• Proficient in anatomy, disease and diagnosis, pharmacology, and medical terminologies  

• Demonstrated knowledge of computers and computer spreadsheet and database financial programs (especially Excel) 

• Ability to act independently, under general supervision 

• Ability to maintain a high level of confidentiality

LANGUAGE SKILLS  

• Ability to read, write and speak English proficiently

PHYSICAL DEMANDS:  The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.  

• Specific vision requirements include the ability to see at close range, distance vision, peripheral vision, depth perception, and the ability to adjust focus 

• While performing the duties of this job, the employee is regularly required to talk and hear 

• Frequently required to stand, walk, sit, use hands to feel, and reach with hands and arms 

• Possess the ability to fulfill any office activities normally expected in an office setting, to include, but not limited to:  remaining seated for periods of time to perform computer based work, participating in filing activity, lifting and carrying office supplies (paper reams, mail, etc.) 

• Occasionally lift and/or move up to 20-25 pounds   

• Fine hand manipulation (keyboarding)

WORK ENVIRONMENT:  The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.  

• Office environment 

• Up to 15% travel 

• The noise level in the work environment is usually low

_Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position. _

The Company provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

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