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Shriners Children’s is an organization that respects, supports, and values each other. Named as the 2025 best mid-sized employer by Forbes, we are engaged in providing excellence in patient care, embracing multi-disciplinary education, and research with global impact. We foster a learning environment that values evidenced based practice, experience, innovation, and critical thinking. Our compassion, integrity, accountability, and resilience define us as leaders in pediatric specialty care for our children and their families.

All employees are eligible for medical coverage on their first day! In addition, upon hire all employees are eligible for a 403(b) and Roth 403 (b) Retirement Saving Plan with matching contributions of up to 6% after one year of service. Employees in a FT or PT status (40+ hours per pay period) will also be eligible for paid time off, life insurance, short term and long-term disability and the Flexible Spending Account (FSA) plans and a Health Savings Account (HSA) if a High Deductible Health Plan (HDHP) is elected. Additional benefits available to FT and PT employees include tuition reimbursement, home & auto, hospitalization, critical illness, pet insurance and much more! Coverage is available to employees and their qualified dependents in accordance with the plans. Benefits may vary based on state law.

Under the direction of the Revenue Integrity Professional Coding Manager and the Senior Professional Coding Educator, the Professional Coding Educator performs comprehensive audits to determine integrity of coding/billing for physician & clinical fees, detection/correction of documentation, coding/billing errors and/or medical necessity of services billed. Audits consist of evaluation of the accuracy of documentation, including E/M and Surgery codes, medical necessity, and compliance with other documentation standards. Researches and applies all federal guidelines & compliance with the overall audit delivery. Develops and executes provider comprehensive educational opportunities/curriculums (coding resources, materials, tools, webinars, etc.) based on audit results, noted trends & changes within coding compliance and regulatory guidelines, while supporting organizational compliance models. Establishes positive working relationships as the subject matter expert with all parties to provide input on risk and ensure a sustained understanding of federal coding compliance requirements. Professional Coding Educator assists in creating, coordinating, and scheduling Provider education and monthly Coding Team education or 1:1 education sessions as necessary.

• Focus on potential documentation improvement opportunities and issues by specialty for Evaluation & Management (E/M) and surgical providers
• Runs reports in EPIC to prepare and present audit results to all providers.
  
  • Identifies problematic trends in Providers’ documentation.
• Reports with suggestions to enhance documentation . Coordinates development of documentation improvement educational materials for providers; coders and other clinical and non-clinical staff
• Train coding staff on E/M and Surgical documentation requirements
• Interpret health record documentation using knowledge of anatomy, physiology, clinical disease processes, pharmacology and medical terminology to identify diagnosis and procedures.
• Identifies educational needs and reporting to RI Senior Professional Educator
• Conduct training sessions on provider-based coding and billing guidelines
• Follows coding guidelines and legal requirements to ensure compliance with federal and state regulations
• Identify trends in documentation deficiencies and communicates areas of improvement to leadership and/or providers
• Acts as a liaison for the clinical staff as it relates to coding and compliance
• Interacts with physicians and other clinical staff regarding documentation issues relating to coding data integrity
• Actively participates in problem identification and resolution and coordinates resolutions between appropriate parties.

This is not an all-inclusive list of this job’s responsibilities. The incumbent may be required to perform other related duties and participate in special projects as assigned.

Required:

• 7 years of professional coding experience
• Experience with Surgery Coding Guidelines, E/M Coding Guidelines, CPT coding, ICD-10, modifiers, HCPCS and Correct Coding Initiative (CCI) edits
• Pediatric, orthopedic and/or injury coding experience
• Experience with education and presentations to staff at all levels including senior leadership, providers and coding staff
• Epic EMR Proficiency
• High School Diploma / GED
• Medical Coding Certification - CCS through AHIMA or CPC through AAPC

Preferred:

• Associate's Degree or higher