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.
Responsible for internal auditing and analyzing professional coding for all service lines.
o Will monitor the audit results closely to identify any potential coding inaccuracy
o Gives the Department the needed support in identifying coding errors
o Gives the practice the security that we are capturing the service accordingly
o Gives providers additional education when needed and requested.
▪ Ensure that medical documentation is following Governmental payers, Managed Care and private
• Review medical records to ensure accuracy of code assignment.
• Guide and educate coding team members by addressing errors, performance issues, and trends identified through reporting.
• Ability to identify and communicate physician documentation and coding opportunities for improvement
• 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.
• Provides statistical reports to 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 interdepartmental meetings as required.
• Prepares/distributes information summarizing opportunities with physician coding monthly.
• Researches, identifies, develops, and assists in implementation of a plan of action to resolve coding disputes with payors.
• Utilizes resource material available in department, CMS, AMA, and AHA to support coding practices.
• 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 confidentiality.
• Proficiency in coding including ICD-10, CPT, E/M, modifiers while maintaining a 90% accuracy.
• Follow and adhere to Standards of Ethical Coding, all applicable regulations and guidelines, and all client specific policies.
• Other duties as assigned based on company needs and projects.
• Ongoing Coding Education and training activities
o Responsible for the development and training of staff within the scope of his/her responsibilities as it relates to Coding Department structure
▪ 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 Assistant Manager in monitoring coding Quality
• Develop and implement coder enhancement strategies
o New Governmental releases information
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.
• 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 skills required for proposal and report development
• Associate degree required. Three (3) 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.
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
• Additional CPMA or COC certification is preferred
• 5-6 years of professional based coding experience is required.
• Professional based coding experience must include all types – Clinic, Behavior Health, hospital rounding, SDS, Teaching & Physician extender provider coding, All specialties