SUMMARY:
As a key member of Soho Managing Company, this position is primarily responsible for coordinating provider education and auditing providers on coding and documentation using current coding guidelines that match insurance companies' compliance audits. It is essential that this individual pays close attention to details and prioritizes detecting coding and documentation deficiencies through continuous audits. This person must deliver audit results promptly to providers, run proper reports for error detection, determine the frequency of audits, prepare educational materials, and lead new coding policy changes.
This person would also be responsible for auditing the medical coders using current coding guidelines that match insurance companies' compliance audits. This person must deliver audit results promptly to coders, run proper reports for error detection, determine the frequency of audits, prepare educational materials, and lead new coding policy changes.
This person can build meaningful relationships with all SohoMD/SohoMC team members and be a liaison between the sub-billing departments, providers, founders, and external vendors. The right candidate loves researching coding guidelines, educating others (teaching/coaching), and analyzing relevant data to help increase coding and documentation accuracy. Must assist in payroll coding clarification to ensure providers have accurate locked notes. Lastly, you are the expert in your industry, so be comfortable providing education to founders for best practice standards to align with organizational objective goals.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
Core duties and responsibilities include the following. Other duties may be assigned.
- Ensure proper education is delivered among team members, and if there are inaccuracies, bring them to the attention of the manager for correction and resolution.
- Conduct quarterly audits on providers and coders in addition to newly hired providers and coders.
- Effectively communicate with other billing staff on rejected or denied coding claims to ensure proper coding for re-submission of claims.
- Follow up with providers on delinquent coding clarifications and unlocked/unsigned notes and cc their supervisors on these requests.
- Conduct targeted audits on specific codes for error detection.
- Complete proper forms to ensure audit data is recovered.
- Ability to run reports for financial data and error collection.
- Responsible for communicating audit findings with the Billing Managers.
- Help train new staff members if needed.
- Keep current with ICD-10 and CPT changes and coding and documentation regulations.
- Keeps current with the Insurance Company’s coding requirements and guidelines and updates the Billing Manager and the rest of the billing department.
- Maintains certification by completing CEUs.
- Help coders code and bill claims if needed.
- Assist Billing Manager and executive leadership team in researching billable CPT codes and ICD–10 codes for possible reimbursement.
- Resolves problems before claim submission and assists with post-submission problem resolution by obtaining information and correcting data.
- Train new coders on coding workflow and behavioral health coding.
- Effectively educate physicians and coders regarding documentation improvement opportunities and proper coding based on current guidelines.
- Effectively educate physicians and coders on improper coding trends and documentation deficiencies based on current guidelines.
- Develop educational materials to address issues or new requirements and be able to present them to providers and the coding team.
- Coach new providers on coding requirements and regulations.
- Monitor for trends in coding corrections, or educational opportunities with coders and providers, and be able to communicate these concerns to the leadership team
SUPERVISORY RESPONSIBILITIES:
- This job has no supervisory responsibilities.
CORE COMPETENCIES:
To perform the job successfully, an individual should demonstrate the following competencies:
- Analytical - Attention to detail; Synthesizes complex or diverse information; Collects and researches data; Uses intuition and experience to complement data; Designs workflows and procedures.
- Design - Generates creative solutions; Translates concepts and information into images; Uses feedback to modify designs; Applies design principles; Demonstrates attention to detail.
- Problem-Solving - Identifies and resolves problems promptly; Gathers and analyzes information skillfully; Develops alternative solutions; Works well in group problem-solving situations; Uses reason even when dealing with emotional topics.
- Project Management - Develops project plans; Coordinates projects; Communicates changes and progress; Completes projects on time and budget; Manages project team activities.
- Technical Skills - Assesses own strengths and weaknesses; Pursues training and development opportunities; Strives to continuously build knowledge and skills; Shares expertise with others.
- Customer Service - Manages difficult or emotional customer situations; Responds promptly to customer needs; Solicits customer feedback to improve service; Responds to requests for service and assistance; Meets commitments.
- Interpersonal Skills - Focuses on solving conflict, not blaming; Maintains confidentiality; Listens to others without interrupting; Keeps emotions under control; Remains open to others' ideas and tries new things.
- Oral Communication - Speaks clearly and persuasively in positive or negative situations; listens and gets clarification; Responds well to questions; Demonstrates group presentation skills; Participates in meetings.
- Written Communication - Writes clearly and informatively; Edits work for spelling and grammar; Varies writing style to meet needs; Presents numerical data effectively; Able to read and interpret written information.
- Teamwork - Balances team and individual responsibilities; Exhibits objectivity and openness to others' views; Gives and welcomes feedback; Contributes to building a positive team spirit; Puts success of team above own interests; Able to build morale and group commitments to goals and objectives; Supports everyone's efforts to succeed.
- Visionary Leadership - Displays passion and optimism; Inspires respect and trust; mobilizes others to fulfill the vision; Provides vision and inspiration to peers and subordinates.
- Change Management - Develops workable implementation plans; Communicates changes effectively; Builds commitment and overcomes resistance; Prepares and supports those affected by change; Monitors transition and evaluates results.
- Delegation - Delegates work assignments; Matches the responsibility to the person; Gives authority to work independently; Sets expectations and monitors delegated activities; Provides recognition for results.
- Leadership - Exhibits confidence in self and others; Inspires and motivates others to perform well; effectively influences actions and opinions of others; Accepts feedback from others; Gives appropriate recognition to others.
- Managing People - Includes staff in planning, decision-making, facilitating, and process improvement; Takes responsibility for subordinates' activities; Makes self-available to staff; Provides regular performance feedback; Develops subordinates' skills and encourages growth; Solicits and applies customer feedback (internal and external); Fosters quality focus in others; Improves processes, products, and services.; Continually works to improve supervisory skills.
- Quality Management - Looks for ways to improve and promote quality; Demonstrates accuracy and thoroughness.
- Business Acumen - Understands business implications of decisions; Displays orientation to profitability; Demonstrates knowledge of market and competition; Aligns work with strategic goals.
- Cost Consciousness - Works within approved budget; Develops and implements cost-saving measures; Contributes to profits and revenue; Conserves organizational resources.
- Diversity - Demonstrates knowledge of EEO policy; Shows respect and sensitivity for cultural differences; Educates others on the value of diversity; promotes a harassment-free environment; Builds a diverse workforce.
- Ethics - Treats people with respect; Keeps commitments; inspires the trust of others; Works with integrity and ethics; Upholds organizational values.
- Organizational Support - Follows policies and procedures; Completes administrative tasks correctly and on time; supports organization's goals and values; Benefits organization through outside activities; Supports affirmative action and respects diversity.
- Strategic Thinking - Develops strategies to achieve organizational goals; Understands organization's strengths & weaknesses; Analyzes market and competition; Identifies external threats and opportunities; Adapts strategy to changing conditions.
- Judgment - Displays willingness to make decisions; Exhibits sound and accurate judgment; Supports and explains reasoning for decisions; Includes appropriate people in the decision-making process; Makes timely decisions.
- Motivation - Sets and achieves challenging goals; Demonstrates persistence and overcomes obstacles; Measures self against standard of excellence; Takes calculated risks to accomplish goals.
- Planning/Organizing - Prioritizes and plans work activities; Uses time efficiently; Plans for additional resources; Sets goals and objectives; Organizes or schedules other people and their tasks; Develops realistic action plans.
- Professionalism - Tactfully approaches others; Reacts well under pressure; Treats others with respect and consideration regardless of their status or position; Accepts responsibility for own actions; Follows through on commitments.
- Quality - Demonstrates accuracy and thoroughness; Looks for ways to improve and promote quality; Applies feedback to improve performance; Monitors own work to ensure quality.
- Quantity - Meets productivity standards; Completes work promptly; Strives to increase productivity; Works quickly.
- Safety and Security - Observe safety and security procedures; Determine appropriate action beyond guidelines; Report potentially unsafe conditions; Use equipment and materials properly.
- Adaptability - Adapts to changes in the work environment; Manages competing demands; Changes approach or method to best fit the situation; Able to deal with frequent change, delays, or unexpected events.
- Attendance/Punctuality - Is consistently at work and on time; Ensures work responsibilities are covered when absent; Arrives at meetings and appointments on time.
- Dependability - Follows instructions, responds to management direction; Takes responsibility for own actions; Keeps commitments; Commits to long hours of work when necessary to reach goals; Completes tasks on time or notifies appropriate person with an alternate plan.
- Initiative - Volunteers readily; Undertakes self-development activities; Seeks increased responsibilities; Takes independent actions and calculated risks; Looks for and takes advantage of opportunities; Asks for and offers help when needed.
- Innovation - Displays original thinking and creativity; Meets challenges with resourcefulness; Generates suggestions for improving work; Develops innovative approaches and ideas; Presents ideas and information in a manner that gets others' attention.
QUALIFICATIONS:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.
EDUCATION AND/OR EXPERIENCE:
- CPC or CCS certification
- Bachelor's Degree (preferred) or Associate degree (required)
- 1+ year of Coding Educator experience.
- 2+ years of Coding and Auditing experience, preferably in Behavior Health and Family Practice.
LANGUAGE SKILLS:
Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations. Ability to write reports, business correspondence, and procedure manuals. Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public.
MATHEMATICAL SKILLS:
Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, percentages, area, circumference, and volume. Ability to apply concepts of basic algebra and geometry.
REASONING ABILITY:
Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.
COMPUTER SKILLS:
To perform this job successfully, an individual should have knowledge of Human Resource systems; Internet software; Payroll systems; Spreadsheet software, and Word Processing software. Proficiency with or the ability to quickly learn the organization's HRIS and talent management systems.
PHYSICAL DEMANDS:
The physical demands described here are representative of those that must be met by an employee to perform the essential functions of this job successfully. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.
- Prolonged periods of sitting at a desk and working on a computer.
- Must be able to lift 15 pounds at times.
- Must be able to access and navigate each department at the organization's facilities.
WORK ENVIRONMENT:
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.
While performing the duties of this Job, the employee is occasionally exposed to outside weather conditions.
The noise level in the work environment is usually moderate.
Job Type: Full-time
Pay: $25.00 - $30.00 per hour
Benefits:
- 401(k)
- Dental insurance
- Employee assistance program
- Employee discount
- Flexible spending account
- Health insurance
- Health savings account
- Life insurance
- Paid time off
- Referral program
- Retirement plan
- Vision insurance
Experience level:
Schedule:
- 10 hour shift
- 8 hour shift
- Monday to Friday
- Weekends as needed
Work setting:
Application Question(s):
- Please specify which certification you currently hold (CPC or CCS)
Education:
Experience:
- medical coding education: 1 year (Required)
- medical coding: 2 years (Required)
- behavioral health coding: 2 years (Preferred)
License/Certification:
- CPC or CCS Certification (Required)
Work Location: Remote
