Physician Education Specialist

Job Description:
Assist with coding, documentation and billing/reimbursement directives for providers and staff by providing regular and ongoing training programs. Perform ongoing internal audits of the provider's documentation of care and the corresponding use of E/M, CPT and ICD-9 codes to ensure billing compliance with all applicable regulations. Coordinate routing communication regarding billing compliance activities to the CPN Corporate Compliance Department. Develop and administer an annualized comprehensive audit program to evaluate billing compliance, including maintaining preparedness for state, federal or payer audits. Development of effective tools and methods of communication to distribute changes to national and regional CMS policy.  Responsible for payer research and payer based education on reimbursement intricacies.  Responsible for development and implementation of project management plans as identified through evaluation of auditing results. Development of internal auditing controls for billing department processes, including charge entry, coding, and accounts receivable. Identify and report compliance related coding issues to the CPN Corporate Compliance Department and participate/present in monthly CPN Corporate Compliance meetings.  Participate in bi-weekly/weekly staff meetings to ensure work is appropriately prioritized and completed in a timely manner. Effectively communicate to CPN customers, both verbally and through regularly scheduled reporting the status of providers that are being audited. Support all departments and staff requesting information and/or assistance regarding all aspects of coding.

Qualifications:
Must have an integral understanding of ICD-9, CPT-4, HC/PCS regulations and familiarity of billing systems. Demonstrated success in problem analysis and implementation of project management plans, with emphasis on the plans that require cross-departmental cooperation.  Must possess Certified Professional Coder (CPC) status. Knowledge of Medicare compliance regulations and associated documentation requirements. Prior experience with IDX preferred.  Minimum of five to seven years of coding/auditing experience in a multi-specialty physician practice or ambulatory care setting.  History of successful and effective provider education on coding and compliance.  Supervisory and/or formal education experience preferred. Strong written and oral communication skills. Understanding of the organization’s goals and objectives. Self motivated and directed with the ability to work independently. Ability to effectively prioritize and execute tasks in a high-pressure environment. Experience working in a team-oriented, collaborative environment. Strong customer-service orientation.