Job Description:

At HealthPartners, you'll find a culture where we live our values of excellence, compassion, integrity and partnership. By working together, we will improve health and well-being, create exceptional experiences for those we serve and make care and coverage more affordable.

We currently have an exciting opportunity for a Coding Specialist & Educator - Gastroenterology. Each coding specialist is responsible for partnering with clinicians and clinic operations staff to support the HealthPartners Revenue Cycle. The specialist is responsible for understanding and optimizing the revenue cycle for their specific department(s) and or clinic location(s) and maintaining a comprehensive understanding of the areas that can hinder optimal revenue capture. This position provides support to clinicians and clinic staff for CPT, HCPCS, and ICD-10 CM coding systems, and acts as a liaison between the delivery sites and compliance operations to support the Physician Services Monitoring Program and related educational activities around coding, billing and compliance.

To be successful the Coding Specialist must:

• Have an in-depth understanding of coding and compliance rules and regulations.
• Have knowledge of Electronic Medical Records (EMR) in the areas of charting tools (i.e. order entry, smart sets etc.), charge dropping, charge update, charge review and follow up work-queues.

Location:

• This is a remote position but will require onsite support when requested.

Required Qualifications:

• Bachelor's degree or equivalent work experience.
• 3 years demonstrated knowledge of coding.
• Certified Professional Coder (AAPC) or Certified Coding Specialist certification (AHIMA).
• 1 year of experience as a certified coding specialist.
• Prior GI coding experience.
• Must have strong surgical coding experience and E/M coding (ambulatory and IP) experience.
• Ability to present information in one-on-one and group settings.
• Ability to communicate information in a professional and confident manner.
• Must demonstrate a thorough understanding of the front and back end revenue cycle components in a physician practice.
• Demonstrated ability in critical thinking, self initiative, and self direction.
• Understanding of physiology, medical terminology, and disease process is required.
• Must understand and be able to apply the following regulations:
  • CMS Evaluation and Management Documentation Guidelines.
  • CMS Teaching Physician Guidelines.
  • CMS Correct Coding Initiative.
  • Third Party Payer Reimbursement Policies and Procedures.

Preferred Qualifications:

• 5 years of experience working with coding systems.
• 2 years of previous experience in medical record chart documentation review.
• 2 years of experience in group education with clinician audiences.
• 1 year working with EpicCare.
• 2 years working in a physician practice setting.
• Prior experience in General Surgery, Vascular, Trauma, Burn, and Wound Care.
• Certified Risk Coder (CRC).
• Demonstrated PC skills in Word, Excel, and Microsoft Access.

Accountabilities:

Revenue Capture

• Ensures all services provided are accurately captured in the medical record and billed appropriately.
• One-on-one chart review with each clinician.
• In-depth understanding of EMR in the areas of charting tools (i.e. order entry, smart sets etc.), charge dropping, and charge update, Charge review work-queues.
• A review of each clinician's individual charting tools and preference lists to ensure accurate CPT, HCPCS and ICD-10 CM coding.
• Investigation into supplies and medications dispensed at each clinic and a review of appropriate billing for them.
• Working all CCI/LMRP edits, claims manager rules and other coding associated charge review WQ rules for each clinic or department supported.
• The ability to provide feedback to each clinician based on identified coding trends.
• Maintains a current knowledge of regulations and legislation regarding billing compliance issues.
• Performs risk adjustment data validation based on accurate diagnosis coding of HealthPartners health plan Medicare Advantage, Minnesota Senior Health Options (MSHO), Prepaid Medical Assistance Program (PMAP, under age 65), and MNCare products utilizing the HCC, HHS-HCC, CDPS, and ACG models.
• Performs risk adjustment data validation based on accurate diagnosis coding of identified HealthPartners health plan Commercial products and other ad hoc requests.

Denial Management

• Working all coding related denials.
• Working all coding related patient complaints.
• The ability to provide feedback to each clinician based on identified denial trends.
• Implement changes and provide education & feedback to clinicians, departments and clinics with regards to denials that impact revenue flow and or capture.

Clinician Education

• Provides coding education (HCPCS, ICD-10 CM, DSM5, & CPT) to clinicians and clinical staff in accordance to the established corporate compliance plan.
• Works with the Education & Compliance Specialist to further support and educate clinicians on their performance in the Physician Services Monitoring Program.
• When clinician documentation issues are identified, work with clinic management and the compliance operations staff to implement corrective action plans.
• Actively train physicians and other clinician on coding and reimbursement issues. Attend clinic and department staff meetings to disseminate information and to become familiar with operational issues within each business unit.
• The RCS will be responsible for implementing corrective action plans to improve revenue cycle outcomes. This may include (but not limited to) creating site-specific education, partnering with Revenue Services staff to implement site-specific revenue improvement projects, understanding how to leverage Epic technology to create revenue capture solutions, or suggesting operational changes at each location.
• Responsible for communicating with other departments regarding process improvements, clinical documentation improvements and/or other educational opportunities.
• Responsible for increasing collaborative efforts between HealthPartners Health Plan and HealthPartners Medical group as it relates to optimization of diagnosis coding, HCC/ACG impacts, revenue recovery, regulatory audits and associated revenue opportunities.

Special projects as assigned.

HealthPartners is recognized nationally for providing outstanding care and experience for patients and members. We offer an excellent salary and benefits package. For more information and to apply go to www.healthpartners.com/careers and search for Job ID #59044.

Additional Information: