Compliance Coding Educator

PRIMARY FUNCTION : A Clinical Documentation Provider Educator will be responsible for providing education to medical providers including but not limited to surgeons, physicians, advanced practice providers, and behavioral health specialists. They will focus on educating providers about properly documenting for services to support the providers chosen CPT and ICD-10-CM diagnosis code in relationship to their treatment of a patient. The Clinical Documentation Provider Educator will also provide feedback loops regarding providers success in implementing education or develop improvement plans for missed opportunities. ESSENTIAL FUNCTIONS: Conduct individual training and group education sessions on proper coding and documentation practices for physicians and staff consistent with industry standards and in compliance with coding guidelines Effectively communicate and implement new coding education and initiatives with providers, including the appropriate change management support to ensure successful adoption Maintain accurate records of the provider audits and make any recommendations for changes in policies and procedures, guidelines, and training programs. Report out Compliance Department statistics to internal and external departments Collaborate with Provider Leaders to complete provider education activities including 1:1 education, clinic education and all supporting provider education activities Provide New Provider/Resident/Fellow onboarding education Identify opportunities for improving coding accuracy through chart review and report review results from the audit team. Conduct follow-up review sessions with providers as needed Special review of project based assignments from Compliance Inquiries Direct and timely provider remediation response to compliance audit plan results Demonstrate the ability to appropriately use coding principles that comply with CMS regulations and company goals and policies Ensure compliance with established coding guidelines, third party reimbursement policies, regulations and accreditation guidelines OTHER FUNCTIONS AND COMPETENCIES Majority of role will be spent (>80%) educating, additional asks may be focused around auditing and providers and providing written compliance guidance to Jefferson employees for clinical documentation, coding and billing. Participate in compliance-related investigations and remediation efforts. Ability to draft formal written material to provide guidance to clinical stakeholders Excellent communication and presentation skills are required Some college level business courses and/or equivalent experience in health field preferred. Minimum of two years' practical clinical documentation improvement and/or auditing experience is preferred. Excellent analytical skills are required. A broad knowledge of the disease process, normal/abnormal findings, reasonable course of treatment, quality assurance, and risk management issues is essential Training skills required to explain requirements and provide guidance to areas experiencing documentation opportunities Qualifications EDUCATIONAL/TRAINING REQUIREMENTS : Bachelor's degree in Health Information Management or related field CERTIFICATES, LICENSES, AND REGISTRATION: One or more of the following certifications required: CPC (Certified Procedural Coder), CCS-P (Certified Coding Specialist - Physician) RHIA (Registered Health Information Management Administrator), RHIT (Registered Health Information Management Technician), COC (Certified Outpatient Coder), CIC (Certified Inpatient Coder), additional certifications in specialty areas is highly encouraged Epic certification or experience with Epic EXPERIENCE REQUIREMENTS : A minimum of five (5) years of progressive experience in coding, reimbursement and regulatory compliance audits either through employment, consulting or other appropriate capacity is required A minimum of three (3) years progressive experience in creating and delivering education is preferred Closing Statement About Jefferson Nationally ranked, Jefferson, which is principally located in the greater Philadelphia region, Lehigh Valley and Northeastern Pennsylvania and southern New Jersey, is reimagining health care and higher education to create unparalleled value. Jefferson is more than 65,000 people strong, dedicated to providing the highest-quality, compassionate clinical care for patients; making our communities healthier and stronger; preparing tomorrow's professional leaders for 21st-century careers; and creating new knowledge through basic/programmatic, clinical and applied research. Thomas Jefferson University , home of Sidney Kimmel Medical College, Jefferson College of Nursing, and the Kanbar College of Design, Engineering and Commerce, dates back to 1824 and today comprises 10 colleges and three schools offering 200+ undergraduate and graduate programs to more than 8,300 students. Jefferson Health , nationally ranked as one of the top 15 not-for-profit health care systems in the country and the largest provider in the Philadelphia and Lehigh Valley areas, serves patients through millions of encounters each year at 32 hospitals campuses and more than 700 outpatient and urgent care locations throughout the region. Jefferson Health Plans is a not-for-profit managed health care organization providing a broad range of health coverage options in Pennsylvania and New Jersey for more than 35 years. Jefferson is committed to providing equal educational and employment opportunities for all persons without regard to age, race, color, religion, creed, sexual orientation, gender, gender identity, marital status, pregnancy, national origin, ancestry, citizenship, military status, veteran status, handicap or disability or any other protected group or status.

Created: 2024-11-09