Certified Professional Coding Specialist

We are seeking a full time Certified Professional Coding Specialist to join our Advanced Care Organization (ACO) team. This is a remote position.

Current certification in medical coding from an accredited institution (such as AAPC or AHIMA) is required. 3+ years of experience in the field in required. 

The Certified Professional Coding specialist will work as a compliance team member to ensure that claims submitted through participating LTC ACO TINs, including PAI Medical Group TINs, meet applicable federal and state guidelines by auditing documentation of credentialed providers for proper code assignment and documentation of medical necessity (both CPT and ICD code assignment). Moreover, this position will be key in assisting with the LTC ACO HCC program ensuring that claims are coded and documented accurately and completely, helping to identify remediation needs of participating providers. Their purpose is to contribute to the overall mission and vision of the organization by working with the Director of Quality Coding and Provider Compliance in identifying the need for education and training to LTC ACO participating providers.

The annual salary for this role is $75000 / year.

Orientation and Onboarding

• Assist in the development of a comprehensive training program to all new providers with a focus on clinical documentation that supports and matches accurate and complete billing
• Documentation and coding auditing of credentialed LTC ACO providers to identify gaps in accuracy and quality related to documentation and coding to identify education needs; and
• Assist in the maintenance of a database to reflect all practitioners' training and audit dates

ACO/MSO Support

• Assist as needed in the development of provider education around the importance and applicability of accurate and complete medical documentation and the ensuing billing documentation and coding;
• Work with team to develop comprehensive ICD-10 billing reports and analysis to ensure previously captured billing codes are properly documented, if applicable, in the current year; and
• Work closely with the director to support new initiatives associated with LTC ACO

COMPLIANCE:

1. Complies with and promotes adherence to applicable legal requirements, standards, policies and procedures including but not limited to those within Compliance and Ethics Program, Standard code of Conduct, Federal False Claims Act and HIPAA.
2. Assist in the maintenance and monitoring of the PAI Medical Group Coding & Billing Compliance Program, conducting auditing to identify gaps, monitoring performance and conducting follow-up auditing
3. Supports the Compliance and Ethics Program within the LTC ACO
4. Ensures timely and accurate reporting and responses to compliance-related issues and monitors the implementation of corrective action plans related to such issues.
5. Participates in provider monitoring and auditing activities and investigations, and implementing quality assurance and performance improvement processes, as required;
6. Provides open lines of communication regarding compliance issues within management area and access to the Integrity Line and ensures that retaliation against staff who report suspected incidents of non-compliance does not occur.
7. Assist in identification of provider educational needs of pertinent Federal and State Standards to reduce the company's vulnerability to fraud, abuse and waste audits;
8. Identifies providers not meeting applicable pass rate for applicable remediation up to and including termination from LTC ACO;
9. Assists with investigations of billing abnormalities as requested, providing internal audits and benchmarking as needed
10. Promptly reports concerns and suspected incidences of non-compliance to supervisor, Compliance Liaison or to the Compliance Office via the Integrity Line.

JOB SKILLS:

• Knowledge of the physician and facility operations and experience in drafting, negotiating and closing complex contracts.
• Position requires excellent interpersonal skills including the ability to communicate clearly both verbally and in writing.
• Familiarity with LTC ACO and its operations and articulate the same to external and internal professionals.

Educational/Vocational Requirements:

• High School diploma or GED completion required
• Certified Professional Coder with a minimum of 3 years' experience with CPT and ICD coding of physician services
• Exceptional communication (verbal and written) required
• Experience with EMR systems

Job Knowledge:

• Good working knowledge of medical terminology and anatomy
• Knowledge of CPT and ICD10 CM billing and coding guidelines
• Good interpersonal skills and a basic understanding of team management concepts
• Ability to gather and interpret clinical data
• Ability to work independently in a fast-paced environment