Cedars-Sinai Clinical Education Specialist - (HCC) in Beverly Hills, California

The Clinical Education Specialist - (HCC) is responsible for reviewing chart notes for proper 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, classroom settings and webinars. 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.

ESSENTIAL JOB DUTIES:

•Acts as documentation and coding liaison to clinicians to include review, education and necessary 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).

•Reviews documentation and coding for new providers for accuracy and charge capture as per standard.

•Responsible for sending coding reports to providers received from coding vendor resources

•Communicates directly with providers on coding feedback and chart review findings

•Prepares necessary reports and communicates results of audits to management, clinicians, and committees as appropriate.

•Reports areas of risk directly to the Manager – Physician Coding Education.

•Maintains a high level of competency related to clinical documentation and coding in assigned specialty and other areas and compliance with government regulations by attending appropriate workshops and seminars.

•Monitors Medicare and other Payer rules for updates and changes.

•Uses spreadsheets to log physician performance results and to re-educate on those outstanding issues and trends.

•Maintains familiarity with such issues as HCFA E/M Documentation Guidelines, HCFA Teaching Physician Documentation Guidelines and the OIG model compliance plans.

•Attends seminars and workshops, as applicable, for updates on new coding rules and regulations.

•Participates in decision making concerning departmental policies and procedures

•Meets organizations objectives set by leadership.

•Understands coding trends by billing area, location, and provider for all groups and physicians.

•Handles in a professional and confidential manner all correspondence, documentation, and files.

•Supports CSMN’s core values, policies, and procedures.

•Follows policies and procedures pertinent to the coding and compliance departments.

KNOWLEDGE, SKILLS AND EXPERIENCE:

•Bachelor’s Degree preferred or International Medicine Graduate Doctor with experience in chart reviews preferred.

•Minimum of three years’ coding experience in advanced professional multi-specialty specific HCC, ICD-10 codes required.

•Minimum of two years’ experience in chart audits/reviews/education and training required.

•Demonstrated experience serving in a consulting or advisory role with regard to coding compliance.

•Must be CPC certified (CPC-A not valid for this position).

•Extensive knowledge of coding surgical procedures and applicable modifiers in multi-specialty setting.

•Understands and applies appropriate PATH guidelines to coding.

•Exhibits high degree of accuracy and attention to detail in all documentation and correspondence

•Ability to interpret and appropriately communicate federal, state and third party billing regulations

•Understands various reimbursement initiatives that are impacted by documentation and coding, including Medicare and Medi-cal

•Knowledge of policies and procedures, as well as data flows in a health care organization; experience with physician billing preferred.

•MS Word and Excel expertise.

•Excellent presentation skills highly desirable.

•Ability to work independently with minimal supervision

•Excellent verbal and written communication skills in the English language.

•Understanding of computer systems, as well as knowledge of computer programs such as Word and Excel.

•Understanding of Epic is preferred.

WORKING ENVIRONMENT:

•Office-based.

•Must be able to perform critical work under deadlines

•Ability to work in a changing environment and handle multiple tasks

•Ability to prioritize work, time sensitive reports and projects