Sr. Coding Consultant (Spokane_ Certification Required)

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POST DATE 9/2/2016
END DATE 10/30/2016

Group Health Cooperative Spokane, WA

Spokane, WA
AJE Ref #
Job Classification
Full Time
Job Type
Company Ref #
Entry Level (0 - 2 years)
Bachelors Degree


The Sr. Coding Consultant will ensure that coding and documentation for assigned areas meet Group Health compliance and quality standards. Serve as a coding resource to staff throughout Group Health. Perform needs assessment and implement coding education for practitioners, ancillary staff, Business Operations and CIS staff. Research complex coding issues and maintain a knowledge base regarding policies and guidelines from CMS and other payers. Teach complex coding issues and concepts. Evaluate medical record documentation against coding and billing compliance standards and provide detailed reports of findings. Develop and implement coding improvement plans. Consult with providers and business office staff to advise on coding issues. Serve as a committee member or project manager for coding issues.

Scope of position may include:

Serves as the coding, documentation, reimbursement and compliance expert consultant to designated specialty and

primary care teams. Demonstrates resource expertise on compliant coding and billing, and regulatory requirements.

Researches clinical specialties, coding changes and guidelines, Federal and State healthcare billing rules and regulatory

requirements, and industry-standard billing practices. Based on audit findings, may lead project work, start to finish,

around corrective compliance actions, reporting directly to the Compliance Officer and legal counsel. Researches and

responds to formal coding and billing appeals

Performs medical record documentation audits of patient care against services and diagnoses reported by providers,

following the GHC Coding and Billing Quality Plan. Develops audit schedules and monitors audit progress to ensure

timelines are met. Reports formal audit findings to Medical Staff and Operations leaders. Develops and implements

improvement plan based on audit findings

This mobile position will travel to local Group Health clinics in the Eastern WA (Spokane) area to conduct onsite evaluations and reviews 25% of the time. Education
Minimum Education Requirements
Bachelors Degree Healthcare field or education-related major. Equivalent combination of education and experience may be accepted in lieu of this requirement.

Preferred Education
Bachelors Degree Bachelors Degree plus relevant experience.

Minimum Knowledge/Skills Requirements
Intermediate In-depth knowledge of ICD-9, CPT and HCPCS coding and documentation. Communication, presentation, interpersonal and customer service skills. Conflict resolution and problem solving skills. Leadership skills. Extensive knowledge of healthcare billing and reimbursement including industry standard billing rules, Medicare, Medicaid, L&I and commercial insurance. Knowledge of adult learning theory and instructional approaches. Knowledge of medical terminology and medical science and disease processes, anatomy and physiology. Organizational skills. Experience in application of compliant coding principles, including Medicare compliance issues. Demonstrated ability to implement up to date and compliant coding information in a complex clinical setting. Computer proficiency in a Windows environment, including MS Word, PowerPoint and Excel.

Preferred Knowledge/Skills
Intermediate Extensive knowledge of Medicare compliance issues and healthcare coding, billing and reimbursement in a fee-for-service environment. Knowledge of APCs and DRGs. EpicCare and Last Word knowledge. Hospital and clinic experience.

Minimum Experience Requirements
5 years progressively responsible experience in ICD-9-CM, CPT and HCPCS coding in a clinic setting, including chart auditing experience. Progressively responsible roles in clinical coding, business and training. Experience in application of compliant coding principles, including Medicare compliance issues.

Preferred Experience
7 years progressively responsible experience in ICD-9-CM, CPT and HCPCS coding in a multi-specialty practice, hospital professional and hospital facility settings, including chart auditing experience. Demonstrated success working with delivery system staff, including creating and delivering formal and informal educational programs. Progressive experience in the application of compliant coding information in a complex clinical setting. Demonstrated experience in enterprise clinical information systems (EpicCare). Project management experience in handling complex and sensitive compliance projects.

Minimum License/Certifications Requirements
At time of hire CPC, CCS-P, RHIT, RHIA, CCS, CPC-H certificate

Preferred License/Certifications
At time of hire CPC or CCS-P.

Group Health is an Equal Opportunity Employer committed to a diverse and inclusive workforce. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status, marital status, age, sexual orientation, gender identity or expression, or any other legally protected status.
Schedule: Full-time
J2W code: ADM1N