Outpatient Coding Quality Education Specialist

Lakeland Regional Health is a leading medical center located in Central Florida. With a legacy spanning over a century, we have been dedicated to serving our community with excellence in healthcare. As the only Level 2 Trauma center for Polk, Highlands, and Hardee counties, and the second busiest Emergency Department in the US, we are committed to providing high-quality care to our diverse patient population. Our facility is licensed for 910 beds and handles over 200,000 emergency room visits annually, along with 49,000 inpatient admissions, 21,000 surgical cases, 4,000 births, and 101,000 outpatient visits.

Lakeland Regional Health is currently seeking motivated individuals to join our team in various entry-level positions. Whether you're starting your career in healthcare or seeking new opportunities to make a difference, we have roles available across our primary and specialty clinics, urgent care centers, and upcoming standalone Emergency Department. With over 7,000 employees, Lakeland Regional Health offers a supportive work environment where you can thrive and grow professionally.

Work Hours per Biweekly Pay Period: 80.00

Shift : Monday - Friday

Location : 210 South Florida Avenue Lakeland, FL (Remote)

Pay Rate : Min $63,793.60 Mid $79,747.20

Position Summary

Under the direction of the facility Coding and Reimbursement Manager, conducts coding quality reviews and audits of chart documentation to assess accuracy, ensure compliance with federal and payer policies, and identifies areas for improvement for hospital outpatient coding. Develops and delivers training on coding accuracy and compliance, staying updated on regulations and providing expert guidance to coders. Provides ongoing coding education and training to coding team and serves as mentor to all new coding team members. Serves as a subject matter expert and resource for coders, providers, and other staff on coding questions, regulatory changes, and best practice. Prepares reports of findings and meets with coders and Coding Leadership to provide education and training on accurate coding practices and compliance issues.

Has thorough knowledge of acute care facility guidelines, modifiers, sequencing rules and the NCCI (National Correct Coding Initiative) edits, OCE (Outpatient Code Editor) edits, Official Guidelines for Coding and reporting for ICD-10-CM/PCS, CPT-4, and HCPCS coding conventions, APC payment classifications and Medicare Conditions of Participation. Will assist the Coding and Reimbursement Manager on preparing presentations and/or interdepartmental feedback.

Responsible for conducting coding and billing training programs for billing and coding specialists. Other duties will include implementing coding department policies and procedures and assisting with reviewing and appealing coding denials.

People At The Heart Of All That We Do

• Fosters an inclusive and engaged environment through teamwork and collaboration.
• Ensures patients and families have the best possible experiences across the continuum of care.
• Communicates appropriately with patients, families, team members, and our community in a manner that treasures all people as uniquely created.

Safety And Performance Improvement

• Behaves in a mindful manner focused on self, patient, visitor, and team safety.
• Demonstrates accountability and commitment to quality work.
• Participates actively in process improvement and adoption of standard work.

Stewardship

• Demonstrates responsible use of LRH's resources including people, finances, equipment and facilities.
• Knows and adheres to organizational and department policies and procedures.

Standard Work: Outpatient Coding Quality Educator Specialist

• Actively participates in team development, achieving dashboards, and in accomplishing departmental goals and objectives.
• Performs internal quality assessment reviews on outpatient facility coders to ensure compliance with national coding guidelines and the LRH coding policies for complete, accurate and consistent coding which result in appropriate reimbursement and data integrity. Helps to coordinate and direct the day-to-day coding educational activities. Facilitates and provides coding educational classes/presentations to staff, as required/when needed.
• Communicates outcomes to the coding team to improve the accuracy, integrity and quality of patient data, to ensure minimal variation in coding practices and to improve the quality of physician documentation within the body of the medical record to support code assignments. Responsibilities also include assisting Coding Leadership in root cause analysis of coding quality issues, performing account reviews, and preparing training documents to assist with coding quality action plans.
• Assists in the review, improvement of processes, education, troubleshooting and recommend prioritization of issues. Researches coding opportunities and escalates as needed. Communicates Coding topics and/or question trends to Coding Leadership for global education.
• Prepares and presents coding compliance status reports to the Coding and Reimbursement Manager and Health Information Management AVP.
• Assists in ensuring coding staff adherence with coding guidelines and policy. Demonstrates and applies expert level knowledge of medical coding practices and concepts.
• Coaches and mentors coding staff as they develop and grow their coding skills. Provides skilled coding support through regularly scheduled coding meetings and as the need arises. Provide one-on-one coaching and support to coding professionals, offering constructive feedback and guidance to improve coding accuracy and documentation practices.
• Assists Coding Leadership with outpatient coding denials.
• Create educational materials, such as manuals, handouts, and multimedia presentations, that effectively communicate complex coding concepts and guidelines.
• Orients, develops and coordinates on-the-job training of instructing them on systems and policies and procedures in accordance to coding compliance guidelines.

Competencies & Skills

Essential:

• Computer experience especially with computerized encoder applications, computer-assisted-coding applications, spreadsheets, and databases.
• Extensive regulatory coding, (ICD-10-CM, CPT-4, HCPCS, Modifiers, and APCs, and associated reimbursement knowledge. Strong knowledge of medical terminology, pharmacology and anatomy and physiology.
• Data Analysis - able to analyze, interpret and share data in a presentation format. Ability to plan and execute educational programs and presentations.
• Communicates clearly and concisely, verbally and in writing. Able to work effectively with other employees, providers and external parties.
• Requires critical thinking skills, organizational skills, written and verbal communication skills, decisive judgment, and the ability to work with minimal supervision.

Qualifications & Experience

Essential:

• Associate Degree
• Bachelor Degree

Essential:

• Health Information Management or other Healthcare degree

Other information:

Experience essential:

5+ years acute care hospital outpatient coding experience and/or coding auditing

5-10 years of educational experience in a facility or consulting setting.

Certification essential:

CCS, CPC, RHIT, or RHIA

Certification preferred:

RHIA