Provider Coding Analyst

Provider Billing Coding Analyst

The Provider Billing Coding Analyst will be responsible for mining local coding data to compare against national benchmarks to identify coding opportunities in each specialty. The position resolves coding opportunities to maximize revenue as well as optimize wRVUs and ensure coding integrity.

Essential Job Statements

• Obtains accurate faculty lists with cFTE for each division/department that correlates with clinical specialties in the benchmarking database.
• Creates cFTE adjusted benchmarks for each division/department for the most used EM and non-EM codes using Vizient/CPSC data and comparing local usage to these benchmarks.
• Monitors EM distributions in each division/department as compared to national trends to identify areas where complexity is below benchmark then pulls representative documentation to identify opportunities for improved physician coding.
• Prioritizes areas for CDI Team to target based on impact.
• Leads regular communication with Department Administrators and Associate Administrators while engaging CDI Medical Directors to teach faculty in their respective areas.
• Uses benchmarking data to create national distributions for critical vs noncritical in ICUs and then compare to local trends to identify potential units that are under coding.
• Pulls representative documentation from EHR to confirm under coding vs an increase in noncritical patients being cared for in ICU settings.
• Provides Technical Support and training to end users on BI tools and reports.
• Partners with Associate CMO for Physician CDI to own and to plan the process of communicating yearly AMA CPT code changes and CMS physician fee schedule final rule and also projects/summarizes impact on physician coding along with revenue.
• Monitors changes in code distributions after educational interventions.
• Updates reporting yearly with new benchmarks.

Patient Population: Not applicable to this position.

Employment Qualifications

Required Education:

Bachelor's Degree in Healthcare Administration, Data Analytics or related degree.

Combination of education and relevant experience may be considered in lieu of a degree.

Preferred Education:

Master's degree

Licensure/Certification Required:

CPC (Certified Professional Coder)

Minimum Qualifications:

Years and Type of Required Experience:

Five (5) years of as a Medical Coding Specialist

Five (5) years of EHR experience (Epic preferred)

Five (5) years Revenue Cycle experience

Other Knowledge, Skills and Abilities Required:

Expert level knowledge EHR Reporting tools: Reporting Workbench, Radar Dashboards, Metrics, Slicer Dicer.

Strong problem-solving and analytical abilities

Strong interpersonal skills and ability to work cross-functionally (Required proficiency).

Ability to effectively communicate with technical and non-technical personas and make complex ideas understood.

Organizationally savvy, with a good understanding of the enterprise's political climate and how to navigate, influence and persuade political waters.

Ability to understand the long-term ("big picture") and short-term perspectives of situations.

Ability to comprehend quickly the functions and capabilities of new technologies.

Other Knowledge, Skills and Abilities Preferred:

Expert level knowledge Epic Reporting tools: Reporting Workbench, Radar Dashboards, Metrics, Slicer Dicer.

5+ years of experience at medium-to-large academic medical center with understanding tripartite mission of Patient Care, Research, and Education

Novice to intermediate knowledge of medical training pathways

Displays intellectual curiosity and integrity.

Working Conditions

Physical Requirements:

Physical Demands: Work Position: Sitting

Additional Physical Requirements/Hazards:

Physical Requirements:

Hazards:

Mental / Sensory: Strong Recall, Reasoning, Problem Solving, Hearing, Speak Clearly, Write Legibly, Reading, Logical Thinking

Emotional: Fast-paced environment, Able to Handle Multiple Priorities, Frequent and Intense Customer Interactions, Able to Adapt to Frequent Change