Coding Quality Reviewer and Educator

Under the direction of the Manager of Coding Policy and Education, research coding and documentation guidelines and creates/updates policies as needed. Develop training materials, work with the Manager to publish materials online, and update materials as needed. Perform audits on schedule or as assigned based on department policy, coding guidelines, payer rules, and/or system policies. Identify external resources, assist with external audits, record results, and schedule related feedback sessions. Work with the manager to provide regularly scheduled education.

Responsibilities

Consistently apply corporate values of respect, honesty, and fairness with the goal of improving regional health through high-value services. Assume responsibility for the principles of the Brown University Health Corporate Compliance Program and Code of Conduct.

• Research coding and documentation guidelines from reliable sources and compile that information into user-friendly manuals.
• Record training materials for coders and providers and work with the Manager to publish recorded materials on the Brown University Health Intranet.
• Prepare for and conduct education sessions that include specialty-specific coding and documentation guidelines, examples of medical records, and resource materials.
• Review findings from external audits and coordinate related feedback sessions with coders, validators, and providers.
• Track internal and external audits and maintain detailed logs. Adhere to the audit schedule.
• Analyze reports on key coding/auditing metrics, identify trends, and report them to the Manager. Assist with ROI analyses.
• Stay updated on coding changes and review payer updates, notifying the Manager of relevant changes.
• Create educational materials including lesson plans and audiovisual aids, and assist with educating validators and coders.
• Abide by the Standards of Ethical Coding and monitor validators for compliance.
• Maintain confidentiality of sensitive information at all times.
• Participate in committees, task forces, and quality improvement teams as needed.
• Perform other duties as necessary.

Basic Knowledge

• Associate degree or 3 years of experience in a medical coding/validating role.
• Certification required: CCS, CPC, RHIA, or RHIT. Specialty certification a plus.
• Excellent communication skills and proficiency in Microsoft Excel, PowerPoint, and Teams applications.

Experience

• Three to five years of progressively responsible outpatient coding experience. Experience in a large multispecialty physician group or complex academic medical center preferred.
• High level of knowledge in ICD-10-CM and CPT-4 coding methodologies.
• Experience with Epic preferred.

Independent Action

• Perform independently within departmental policies and procedures, with minimal supervision.

Work Environment

• Remote work from home.

Supervisory Responsibility

• None

Brown University Health is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, age, ethnicity, sexual orientation, ancestry, genetics, gender identity or expression, disability, protected veteran or marital status. Brown University Health is a VEVRAA Federal Contractor.