Coding Provider Educator - Remote within NC, NC, OK, AR, OR, WA, NY, CA, CT, DE
Provider Educator will audit, educate and monitor providers for EM levels, office procedures and diagnosis coding adhering to the audit and training schedule set forth in the GoHealth Coding Audit Protocols. Maintain accurate records of the provider audits and make any recommendations for changes in policies and procedures, guidelines and training programs. Develop and conduct provider training and maintain a positive learning experience.
Must be available for day and evening phone/web training when needed.
High School Diploma or GED required
Bachelor’s Degree preferred
Minimum of 5 years out patient EM/office procedure coding
Minimum 2 years training providers on chart documentation and coding guidelines
Knowledge of revenue cycle
Experience with delivering presentations, conducting one on one education with providers, teaching a coding class, or speaking at coding seminars
Medical Coding Certificate – RHIT, CPC, or CCS-P
Additional Knowledge, Skills and Abilities Required Federal laws and regulations affecting coding requirements
Working knowledge of payor guidelines
Knowledge of billing practices
Knowledge of EMR required, eClinical Works and/or Epic preferred
Knowledge of PowerPoint, Microsoft Word and Excel
Strong communication skills.
Excellent interpersonal skills
Additional Knowledge, Skills, and Abilities Preferred Denial Management
Essential functions are those tasks, duties and responsibilities that comprise the means of accomplishing the job’s purpose and objectives. Essential functions are critical or fundamental to the performance of the job. They are the major functions for which the person in the job is held accountable. Following are the essential functions of the job.
Provider Audit/Education Duties:
• Performs focused audits, reviewing medical record documentation that supports billing, risk management and legal requirements. Works closely with Corporate Compliance to assist in identifying where there is a need for improved coding compliance and documentation
• Develops and implements onsite education and training to all provides to ensure accurate documentation and coding in real time. Serves as a consultant to all providers, helping them to improve documentation and proper coding and ensuring maximizing reimbursement
• Develops and implements coding education for all new hire providers. Works with Compliance to ensure timely baseline audits and re-audits, providing necessary identified educational sessions.
• Performs data analysis, evaluating denial reports of all payers; reporting on physician statistics regarding coding compliance, benchmarking and revenue enhancement opportunities
• Participates in committees and meetings as it pertains to coding, billing, and documentation
• Prepares written reports of the audit findings by provider/practice
• Assists with claim denial reports to ensure optimal reimbursement
• Provides clarification on GoHealth coding and compliance policies
• Meets with the Compliance Committee as needed to review audits, discuss concerns, make plans for processes/procedures
Required knowledge, skills and ability:
Customer service skills:
• Ability to represent the Department in a professional manner when interacting with patients, guests,
physicians and their staff
• Ability to handle issues professionally
• Ability to follow through with customers
• Ability to communicate effectively to providers regarding audit results
• Ability to communicate effectively to centers and staff regarding departmental policy
• Ability to type proficiently
• Ability to function effectively as extension of the Center
• Be flexible and open-minded in thought processes
• Maintain focus under pressure
• Share relevant information with other team members
Note: this job description is not inclusive of all the duties of the position. You may be asked by leaders to perform other duties. Management reserves the right to revise this position description at any time.