Medical Coding Analyst

POSITION SUMMARY

Under direct supervision of the Training and Development Director, performs audits of medical claims for compliance with federal coding regulation and guidelines. This position also reviews and resolves coding issues related to billing; researches complex coding issues and participates in process improvements related to coding and EM management. This position will also provide education to providers and staff on correct documentation, coding, and billing of visits.

EXPECTATIONS

Every Adelante employee will strive to maximize their performance and contribution to Adelante Healthcare and the community we serve every day. Employees are expected work in a manner that demonstrates a commitment to quality, patient safety, employee engagement, innovation, and the highest standards of personal integrity, professionalism and competence.

OUR CORE VALUES

• Excellence
• Integrity
• Sustainability
• Respect
• Compassion
• Learning

ESSENTIAL SKILLS AND EXPERIENCE

• Associates degree preferred
• High school diploma or GED from an accredited institution
• Coding certification through an accredited organization, including Certified Coding Specialist (CCS) through AHIMA or Certified Professional Coder (CPC) AAPC required
• Detailed knowledge of medical coding systems, procedures, and documentation requirements
• Five (5) years of coding experience with a focus on E/M Coding and OBGYN preferred
• Highly effective written and verbal communication skills
• Ability to provide guidance and training to professional and technical staff in area of expertise
• Ability to analyze and solve problems
• Knowledge of legal, regulatory, and policy compliance issues related to medical coding and billing procedures and documentation
• Knowledge of current and developing issues and trends in medical coding procedures requirements
• Ability to adapt and modify medical billing procedures, protocol, and data management systems to meet specific operating requirements
• Valid Level One Fingerprint Clearance Card issued by the Arizona Department of Public Safety for all specialty behavioral health locations

POSITION REPONSIBILITIES/ESSENTIAL

EXPECTATIONS

• Ensuring that charges are being captured, documented, and billed in accordance with policies and procedures as well as payer regulations and CPT/ICD-10 guidelines
• Review pending charges for submission to ensure accuracy of the billing, make approved changes where necessary, or return to the provider to correct the claim prior to billing to the plans
• Proactively identify areas of opportunity to improve the charge capture processes to meet compliance regulations and maximize revenue
• Collaborate with the Revenue Cycle Director to implement a chart audit process to ensure charges are being documented, captured and billed so that training can be provided to staff
• Present audit findings and action items to Revenue Cycle Director to improve the charge capture and billing process
• Meet individually or with a group of providers to educate and train on compliant coding practices based on chart review findings
• Prepare and create training materials and conducts periodic education and training sessions with providers and coding staff on medical coding and documentation requirements
• May provide guidance to coders
• Delegate workload to staff, ensure charges are being regularly reviewed, corrected, and submitted timely
• Train and instruct medical coders and providers on appropriate coding practices in accordance with payer and regulatory requirements
• Research, analyze, and respond to inquiries regarding coding, documentation, denials, and billing
• Remain current with industry changes and ensure all staff are educated on such changes
• Interacts with providers and management to review and/or implement codes and to update charge documents

Additional Duties and Responsibilities

• Other duties as request or assigned

PCMH

All employees are responsible for promoting and participating in interdisciplinary communication and collaboration to enhance the delivery of quality across the health care system. Employees should maintain an environment which supports and engages patients and co-workers in a caring team based model to promote wellness and improve health outcomes.

Adherence to Compliance and Code of Conduct

All employees are required to comply with Adelante Healthcares written standards, including its Compliance Program and Standards of Conduct, policies and procedures and reporting of any conduct that potentially violates Adelantes legal or compliance requirements. Such compliance will be an element considered as part of the regular performance evaluation.

PHYSICAL DEMANDS AND WORK ENVIRONMENT

The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Physical demands: While performing the duties of this job, the employee may be required to sit for long periods of time, is required to stand, walk, use hands to handle or feel objects, tools or controls; reach with hands and arms; climb steps/stairs; balance; stoop, kneel, crouch or crawl; talk or hear; smell; manage stress as it relates to essential job functions. The employee must frequently lift and/or move up to 25 pounds without assistance, and may occasionally be required to lift or move up to 50 pounds with assistance. Specific vision abilities

required by the job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.

Work environment: While performing the duties of this job, the employee is exposed to weather conditions prevalent at the time when traveling to various clinic sites. The noise level in the work environment is usually moderate. The employee may be subject to health hazards (contagious diseases, blood borne pathogens, etc.) when working in the clinic area.

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