Coding Compliance Educator

Coding Compliance Educator

Headquartered in Tacoma, WA, Sound Physicians is a physician-founded and led, national, multi-specialty medical group made up of more than 1,000 business colleagues and 4,000 physicians, APPs, CRNAs, and nurses practicing in 400-plus hospitals across 45 states. Founded in 2001, and with specialties in emergency and hospital medicine, critical care, anesthesia, and telemedicine, Sound has a reputation for innovating and leading through an ever-changing healthcare landscape with patients at the center of the universe.

Sound Physicians offers a competitive benefits package inclusive of the items below, and more:

• Medical insurance, Dental insurance, and Vision insurance
• Health care and dependent care flexible spending account
• 401(k) retirement savings plan with a company match
• Paid time off (PTO) begins accruing immediately upon start date at a rate of 15 days per year, in accordance with Sound's PTO policy
• Ten company-paid holidays per year

The Coding Compliance Educator works under the supervision of the Director of Compliance Operations to ensure coding and documentation guidance is consistent across the organization. The Coding Compliance Educator is responsible for managing and responding to provider inquiries. The Coding Compliance Educator will work very closely with providers and clinical leadership to provide education regarding compliance with guidelines and best practices. The Coding Compliance Educator will present at clinical leadership meetings upon request.

Essential duties and responsibilities:

• Excellent communication skills and ability to build strong relationships with clinical leadership and providers in a non-punitive manner.
• Preparation and creation of presentations for meetings with providers and clinical leadership; strong preparation skills during meetings.
• Trains providers and clinical leadership on coding guidelines, ensuring compliance around clinical documentation, coding guidelines, MDM, acuity, ICD10, and coding industry standards and best practices.
• Assist Director of Coding Compliance with creation of job aids to describe coding rules for specialties including, Critical Care, Hospital Medicine, and Telehealth.
• Review and analyze new CPT coding guidelines and create education material annually or as needed based on changes.
• Reviews audit results with auditing team, to identify and analyze trends, and recommend and implement appropriate education.
• Schedule regular site meetings with all providers and clinical leadership to provide coding and clinical documentation improvement to coding accuracy.
• Manage and respond timely to provider inquiries.
• Assist the Director of Coding Compliance with maintaining a formalized review process that incorporates regular audits (provider, coding and documentation adequacy) and coordinates ongoing monitoring with education to provider.
• Works with auditors and conducts trend analyses to identify patterns, variations in coding practices and case-mix index, including areas of risk and comparing coding profiles with national norms.
• Develops and coordinates educational and training programs regarding elements of the coding compliance program, such as appropriate documentation, accurate coding, data compatibility, consistency and monitoring for compliance to improve the quality of clinical data supported.
• Provides feedback and focused educational programs based on the results of auditing and monitoring activities to affected providers and clinical leadership.
• Collaborates with Director of Coding Compliance to initiate corrective action plans, including the Administrative Good Standing status.
• Demonstrates up-to-date knowledge of healthcare regulatory, coding mandates and OIG work plan.
• Analyze audits and RA findings.
• Prepares information for Board meetings upon request.
• Attends coding conferences, workshops, and in-house sessions to receive updated coding information and changes in coding and/or regulations.
• Performs miscellaneous job-related duties as assigned.
• Ensures strict confidentiality of patient, confidential, and proprietary information.

Values:

• Self-motivated: Proactively jumps in to start a task or project with limited direction; asks to take on more responsibility and what's next.
• Likes people: Genuinely enjoys engaging with and helping others; feels a sense of accomplishment through helping and working with other people.
• Adaptable: Demonstrates flexibility and a willingness to change as circumstances evolve.
• Team Player: Proactively seek to work with others to accomplish a common goal. Willingness to share challenges and successes with others.
• Resourceful: Proactive willingness to utilize available information and tools to figure things out.

Knowledge, skills and abilities:

• Ability to clearly communicate with providers and clinical leadership
• Strong knowledge of auditing concepts and principles
• Knowledge and understanding of professional fee coding (CPT and ICD 10), physician group practice revenue cycle processes, and regulatory compliance issues related to billing and coding, documentation standards, and third-party payer processes
• Strong written and verbal communication and interpersonal skills
• Ability to work independently to analyze and solve problems
• Ability to use independent judgment and to manage and impart confidential information
• Ability to adapt, modify and prioritize audit functions as required

Education and experience:

• Bachelor's degree in a health sciences discipline, business or related field desired.
• 3 years of experience in coding compliance, preferably with a focus on auditing or education in hospital or physician practice billing and coding operations or compliance.
• Coding Certification required (Any of CPC, CPC-H, CCS, CCS-P)

Pay Range: $70,000k-$80,000 annually. Exact pay will be determined based on candidate experience, geographical location, and size/complexity of the program being supported.

Sound Physicians is an Equal Employment Opportunity (EEO) employer and is committed to diversity, equity, and inclusion at the bedside and in our workforce. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, gender identity, sexual orientation, age, marital status, veteran status, disability status, or any other characteristic protected by federal, state, or local laws.

This job description reflects the present requirements of the position. As duties and responsibilities change and develop, the job description will be reviewed and subject to amendment.