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Review medical record documentation and
accurately assign ICD-9, CPT, and HCPCS codes according to
established correct coding guidelines and AHIMA standards of
ethical coding.
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Serve as resource person for coding and
compliance questions.
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Instruct physician and non-physician
practitioners on compliance regulations and coding guidelines.
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Document coding and compliance education
sessions with medical providers i.e., attendance, methods,
context, and evaluation of feedback.
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Train and supervise support staff involved
in various aspects of coding.
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Create and maintain up-to-date coding
compliance manual, materials, and policies to be used for staff
education, training and guidance.
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Implement and monitor compliance with the
OIG's Work Plan.
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Perform audits/internal monitoring of
medical record documentation and corresponding coding. Provide
reports and feedback. Educate on deficient areas discovered in
audit.
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Make recommendations and follow-up.
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Quality check all Medicare coding prior to
billing.
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Summarize and distribute updates and changes
to coding and compliance issues from third-party payers.
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Analyze problem claims, compare coding with
medical record documentation and make any appropriate changes.
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Consult with medical providers when
necessary for reasons of clarifications of coding and compliance
issues.
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Track rejections/denials of claims based on
coding patterns and/or follow claims after changing to make sure
it is adjudicated appropriately. Assess risk based on the types
of denial/rejections received.
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Document and report non-compliance concerns
to the Compliance Director and/or Compliance Officer for further
follow-up.
-
Report to and serve as a member of the
compliance committee; meet with the provider liaison to discuss
coding and documentation issues.
-
Actively participate in the transition to an
electronic medical record.
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Other duties as assigned.
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