Summary of Position

This position is responsible for auditing, training and monitoring of medical information and quality of coding and provider documentation for Premier HealthNet, Premier Health Specialists, and Upper Valley Professional Corp collectively known as The Network. This position will report directly to the Physician Practice HIM Manager.

Nature and Scope

The Coding Analyst is responsible for the research, training, follow-up of coding and provider documentation compliance which affect the operations and reimbursement of The Network. The Coding Analyst will act as an on call resource; conduct physician and staff training with regard to coding and documentation compliance and charge audits. This Analyst will consult with Physician Practice HIM Manager regarding documentation issues and practice patterns. The candidate will interact with physicians, practice managers, office staff, as well as hospital based and non-hospital based resources.

Principal Duties and Responsibilities:
May include some or all of the following

1. Create, implement, and audit compliance and education program.

2. Serve as a consultant and educator to ensure coding and documentation across the organization

3. Prepare written and oral summaries of documenting, coding, and charge entry performance to provide to physicians and senior leadership an understanding and explanation of results.

4. Identify outliers and under-performance areas and communicate to the appropriate relevant parties using the proper chain of command. Work with Operations Directors, office managers and physicians to develop and implement strategies to improve results.

5. Keep up to date and in compliance with all current and future changes in coding/documentation rules and regulations that impact current policies and procedures including implementation and enforcement in accordance with government and commercially contracted guidelines. Develop and maintain current knowledge of the state of health care in regards to reimbursement, federal regulations, trends, and forecasting.

6. Identify internal control weaknesses and business improvement opportunities. Look for ways to provide more cost effective services through the use of technology (EPIC). Evaluate and possibly assist in redesigning current workflows in order to improve efficiencies and productivity in the documentation, coding and charge entry.

7. Enhance communication between Corporate and Physician Practice environments to ensure a cooperative atmosphere.

8. Act as a liaison and first-line point of contact for questions, errors and new issues for the physicians and their office staff.


Certification: RHIT or CPC required

Experience: Two (2) years experience with physician office coding.
Demonstrated working knowledge of professional billing
Experience with Epic EMR preferred.

Skills: The candidate must demonstrate successful presentation techniques and possess excellent organizational, customer service, and both oral and written communication skills. He/She should possess a strong knowledge base of ICD-9-CM, CPT and HCPCS coding, financial analysis techniques, costing, federal and state regulatory processes, insurance billing, third party payor requirements, outcome measurements, medical information and practice patterns. He/She should also have advanced knowledge of Microsoft Word and Excel.