Essential Functions

Audits charts and reviews clinical records, ensuring all diagnostic and procedural codes and modifiers strictly adhere to requirements.
Identifies trends in improper coding or communication shortcomings that may lead to claim denials or audits.
Complies with all medical coding guidelines and monitors evolving regulatory and industry changes.
Provides targeted education, direct coaching, and facilitates training programs tailored to each medical specialty based on audit findings.
Follows up and clarifies any information that is not clear with the rendering provider.
Collaborates with IT and EHR teams to improve charge automation and optimize workflows.
Conducts ad-hoc audits to ensure fidelity to coding guidelines.
Serves as a subject matter expert for Southwest Network on accurate and efficient coding practices.
Analyzes medical records and identifies documentation deficiencies.

Nonessential Functions

Follows policies and procedures and adheres to the requirements of the Corporate Compliance Program.
Ensures confidentiality of verbal and written information in accordance with HIPAA standards and Southwest Network policy, and adheres to the legal, ethical, and professional guidelines adopted by Southwest Network.
Performs other duties as assigned.