Position Summary:
**This opportunity is a hybrid role requiring occasional on-site presence and residency in the Central FL area***
At Orlando Health, we are ordinary people with extraordinary individuality, working together to bring help, healing and hope to those we serve. By daily embodying our over 100-year legacy, we have grown into a 3,900-bed healthcare organization that delivers care for more than 142,000 inpatient and 3.9 million outpatient visits each year. Our 24 award-winning hospitals and ERs, 9 specialty institutes, 14 urgent care centers, 100+ primary care practices and more than 60 outpatient facilities serve communities that span Florida’s east to west coasts and beyond.
Orlando Health is committed to providing you with benefits that go beyond the expected, with career-growing FREE education programs and well-being services to support you and your family through every stage of life. We begin your benefits on day one and offer flexibility wherever possible so that you can be present for your passions. “Orlando Health Is Your Best Place to Work” is not just something we say, it’s our promise to you.
Performs, develops, and implements coding related efficiency processes to monitor professional coding to ensure optimal efficiency and follow the controlling compliance guidelines with governmental and private payers. The Physician Coding Education Specialist is responsible for analyzing physician coding trends and providing educations that will contribute to effective productivities.
- Location: Hybrid, Remote 90% & On-site 10%
- Status: Full Time (exempt)
- Days: Monday through Friday
- Shift: Day (flextime plan with the possibility of occasional early morning/evening hours)
**This opportunity is a hybrid role requiring occasional on-site presence and residency in the Central FL area***
Responsibilities:
Essential Functions:
- Responsible for internal auditing and analyzing professional coding for all service lines.
o Monitor the audit results closely to identify any potential coding inaccuracy
o Providesthe Department/Practice the needed support in identifying coding errors
o Works with the practice to ensure services are captured accordingly.
o Provides additional education to practices/providers/coders as needed and requested.
- Ensure that medical documentation is following Governmental payers, Managed Care and private insurances guidelines
- Review medical recordsto ensure accuracy of code assignment.
- Guide and educate coding team members by addressing errors, performance issues, and trends identified through reporting.
- Identify and communicate physician documentation and coding opportunitiesforimprovement
- Takes an active role in developing and presenting educational programs to physicians, physician extenders, and physician offices.
- Effectively communicates best practice physician coding related feedback with physicians, non-physician providers, physician office staff, administration, practice managers, and team members of the Physician and Professional Services Central Business Office.
- Takes the initiative to identify and solve complex trending coding issues affecting the physician revenue cycle and provide the necessary feedback to correct claims on a go-forward basis as well as recovered underpaid amounts.
- Collaborates with Physician and Professional Services Central Business Office to ensure appropriate and complete follow up of patient accounts to ensure coding accuracy for payor guideline reimbursement.
- Addresses all Orlando Health departments professionally and positively, in all settings, by always maintaining a high level of professional demeanor and dress.
- Providesstatisticalreportsto deliver accurate documentation of ongoing internal coding efficiency process.
- Conducts focused physician reviews as needed and provides data to manager.
- Maintains 90% physician coding accuracy rate.
- Attends payor, departmental and interdepartmentalmeetings asrequired.
- Prepares/distributes information summarizing opportunities with physician coding monthly.
- Researches, identifies, develops, and assistsin implementation of a plan of action to resolve coding disputes with payors.
- Utilizesresource material available in department, CMS, AMA, and AHCA and federal registry to support coding practices.
- Perform physician queriesfor coding and documentation clarification during concurrent chartreview process.
- Addresses all Orlando Health departments professionally and positively, in all settings, by always maintaining a high level of professional demeanor and dress.
- Serves as a preceptor to new coders.
- Takes an active role in developing and presenting educational programs to Physician & Professional Services team, physicians, physician extenders, physician offices, and all members of the coding team and manager.
- Maintains patient and coder confidentiality results.
- Proficiency in coding including ICD-10, CPT, E/M, modifiers while maintaining a 90% accuracy.
- Adhere to Standards of Ethical Coding, all applicable regulations and guidelines, and all clientspecific policies.
- Other duties as assigned based on company needs and projects.
- Ongoing Coding Education and training activities
- Responsible for the development and training of staff within the scope of his/her responsibilities as it relates to Coding Department structure
- New providers
- New Coders
- Testing, training, and mentoring incoming coders according to the coding guidelines and individual skills
for the Division for which the coder will be assigned.
- Existing providers
- Collaborate with Physician Coding Leadership in monitoring coding quality
- Participate in Health Plan Audits
- Develop and implement coder enhancementstrategies
o New Governmental releasesinformation
o Basic in-house coders auditing
o In-Service presentation during coders’ meeting
- Provide daily support to all assigned practice managers on their coding related questions
- Maintains reasonably regular, punctual attendance consistent with Orlando Health policies, the ADA, FMLA and other federal, state, and local standards.
- Maintains compliance with all Orlando Health policies and procedures.
Other Related Functions:
- Attends payor, departmental and interdepartmental meetings asrequired.
- Other duties as assigned based on organization needs and projects.
- Works in collaboration for testing, training, and mentoring incoming coders according to the coding guidelines and individual skills for the Division for which the coder will be assigned.
- Conducts focused physician reviews as needed and provides data to manager.
Qualifications:
Skills Knowledge:
- Excellent knowledge of CPT-4, ICD-10-CM/PCS and HCPCS coding principles, governmental regulations, protocols, and thirdparty payer requirements pertaining to billing, coding and documentation
- Knowledge of medical terminology
- Experience working with Electronic Medical Records
- Ability to work independently
- Strong interpersonal and presentation skills paired with advanced written and verbal communication skills
- Strong analytical and writing skillsrequired for proposal and report development
Education/Training:
- Associate degree required.
- Five (5) years of directly related work experience may substitute for the associate degree.
- Possesses exceptional knowledge in Microsoft Office Word, Outlook, and PowerPoint as well as moderate to expert experience with Microsoft Excel.
- Thorough knowledge of official coding guidelines as per AMA, AHA, and CMS as evidenced by results of coding skills test of 90% or better.
Licensure/Certification:
Must maintain one (1) of the following national certifications:
- Certified Professional Coder (CPC) through the American Academy of Professional Coders
- Certified Coding Specialist (CCS) through the American Health Information Management Association (AHIMA)
- Certified Coding Specialist-Physician (CCS-P) through the American Health Information Management Association (AHIMA)
- Certified Medical Coder (CMC) through Practice Management Institute
- Certified Professional Medical Auditor (CPMA)
- CEMA certification via National Alliance of Medical Auditing Specialists
Experience:
- 5-6 years of professional based coding experience isrequired.
- Professional based coding experience must include – Office, Inpatient, Bedside Procedures, Surgical Coding, Teaching & Physician extender provider coding, multiple specialties is desired.
- Level one (1) Trauma hospital experience is preferred.
- Experience with a large organization, multi-location, multi-specialty with high volume providers is preferred.
