Under limited supervision, determines the adequacy of medical records documentation, coding and billing for all providers across all clinical specialties. Collaborates with clinical operations, CBO and the Compliance Office. Provides corresponding training and support to providers, professional fee billing staff, clinic staff, administrators, and other personnel on third party payer documentation and billing requirements. Develops coding documentation materials to be used as training tools. Assists in responding to inquiries from providers and staff. Assists in preparing periodic coding updates materials for providers and staff.

Principal Responsibilities and Tasks

The following statements are intended to describe the general nature and level of work being performed by people assigned to this classification. These are not to be construed as an exhaustive list of all job duties performed by personnel so classified.

• Conducts independent reviews/audits on the adequacy of medical record documentation to support the codes selected by providers or by billing office coders.
• Analyzes documentation or coding patterns by a provider, division or department that poses a compliance risk and recommended solutions to address the problem(s).
• Provides feedback to providers on the results of their medical record documentation reviews and gives targeted training as needed, either individually or to groups.
• Assists in the development of medical record documentation standards and requirements related to clinical services billing. Develops training and educational materials to address documentation and coding deficiencies and educate staff and providers on new requirements.
• Conducts concurrent coding reviews for coding staff, and provides timely feedback to the Director.
• Conduct audits of provider documentation on an ad-hoc basis as requested by the Director.