Cedars-Sinai Coding Education Specialist - PBS Compliance in Beverly Hills, California
The Coding Education Specialist (CES) is responsible for reviewing chart notes for accurate code assignment with an emphasis on provider education, documentation and coding improvement, and revenue capture. The CES provides education to clinicians, clinic staff, and others as needed via face-to-face meetings, Teams, WebEx and classroom settings. The CES also develops, maintains and presents coding and compliance educational materials to staff and clinicians. In addition, the CES collaborates with the Manager of Physician Coding Education to support the needs of PBS where coding expertise/education is needed. This position is also responsible for analysis and assessment of governmental and non-governmental payer audits, conducts focused reviews and monitors provider compliance with medical record documentation after training and education.
Job Duties and Responsibilities:
Acts as documentation and coding liaison to clinicians to include review, education and vital follow-up to help ensure that clinical documentation and coding services meet government and organizational policies and procedures.
Analyzes and provides education on revenue capture, clinical documentation including Electronic Health Record (EHR) requirements, coding accuracy and denial management to clinicians and clinic staff.
Assists in determining educational needs based on documentation reviews, provider/staff feedback, data analysis (bell curves).
Train new providers and prepare educational materials based on practice questionnaire completed by provider.
Reviews documentation and coding for new providers for accuracy and charge capture as per standard.
Responsible for sending coding reports to providers acquired from coding vendor resources.
Communicates directly with providers on coding feedback and chart review findings.
Prepares vital reports and communicates results of audits to management, clinicians, and committees as appropriate.
Prepare and customize PowerPoint presentation as needed based on requests and needs.
Uses spreadsheets to log physician performance results and to re-educate on those outstanding issues and trends and reports areas of risk directly to the Manager – Physician Coding Education.
Maintains a high standard of proficiency related to clinical documentation and coding in assigned specialty and other areas and compliance with government regulations by going to appropriate workshops and seminars.
Look after Medicare and other Payer rules for updates and changes and supports CSMN’s core values, policies, and procedures.
Maintains familiarity with such issues as HCFA E/M Documentation Guidelines, HCFA Teaching Physician Documentation Guidelines and the OIG model compliance plans.
Takes part in seminars and workshops, as applicable, for updates on new coding rules and regulations.
Understands coding trends by billing area, location, and provider for all groups and physicians and
handles in a professional and confidential manner all correspondence, documentation, and files.
High school diploma or GED required. Bachelor's degree preferred.
Certified Professional Coder (CPC) required.
Three (3) years of experience in Coding in advanced professional multi-specialty specific CPT, ICD-10 codes required.
Two (2) years of experience in chart audits/reviews/education and training required.
Cedars-Sinai is an EEO employer. Cedars-Sinai does not unlawfully discriminate on the basis of the race, religion, color, national origin, citizenship, ancestry, physical or mental disability, legally protected medical condition (cancer-related or genetic characteristics or any genetic information), marital status, sex, gender, sexual orientation, gender identity, gender expression, pregnancy, age (40 or older), military and/or veteran status or any other basis protected by federal or state law.