SCOPE/GENERAL PURPOSE OF JOB:
The medical consultant is responsible for providing consulting services to clients (i.e., physicians, physician groups, billing companies, hospitals, health systems, health care attorneys, and other health care entities) including coding/documentation audits, billing audits, compliance audits, general and targeted educational sessions, expert advice on coding, documentation, and billing topics, operational assessments and other engagements as assigned.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
- Provides consulting services with client in accordance with their contractual agreement (onsite and remote).
- Performs comprehensive documentation, coding, billing and/or compliance audits in accordance with client contract
- Create accurate well written reports summarizing audit findings and recommendations which include clear explanation of errors and references for authoritative guidance supporting recommendations when applicable.
- Present audit findings and recommendations in person or by phone
- Customize training material for client specific needs
- Deliver onsite or remote educational sessions
- Conducts and participates in webinar trainings, conference calls, creation of documents and materials for clients
- Other consulting projects as assigned (ex. CDM reviews, workflow assessments, denials management evaluations, etc.)
- Maintains an accurate record of time spent on all assignments (client and non-client work)
- Assist in creating and updating coding reference manuals and presentations as needed
- Ability to meet monthly financial targets defined for the position
- Communicates with Manager regarding client concerns, issues or assistance as needed
- Monitors government regulations & programs and presents information to the company and clients
- Prepares industry related articles for publication when requested
- Strives to achieve maximum exposure and strong public image of Revenue Cycle Coding Strategies to all industry stakeholders
- Works on ensuring a strong, positive relationship between all company divisions
- Ensures compliance with company Policies and Procedures, State, and Federal Regulations
- Maintains confidentially of all information related to patients, medical staff, finances and all other company and client information.
- Submits accurate invoices and expense reports timely to the appropriate department following company policies
- Adheres to all RCCS policies and procedures
- Additional duties as assigned.
EDUCATION AND/OR EXPERIENCE:
- Bachelor’s degree preferred but not required.
- Coding certification(s) required by one or more of the following bodies: AHIMA, RCCB, AAPC.
- Willingness to obtain additional industry specific certifications within one year of employment.
- Minimum three (3) years of experience as a consultant, auditor/educator, or compliance professional in healthcare.
- Knowledge of coding, documentation, and reimbursement
- Knowledge of organization policies and procedures
- Knowledge of health care administration principles
- Knowledge of business office procedures as they relate to the healthcare industry
- Skill in exercising initiative, judgment, discretion, and decision-making to achieve objectives.
- Skill in identifying and resolving problems
- Ability to communicate effectively and professionally with all levels of staffing in health care provider organizations and business related organizations
- Ability to establish and maintain effective professional working relationships with all employees and clients
- Knowledge of CPT-4, diagnosis and HCPCS coding.
- Highly detail-oriented individual with outstanding analytical and writing skills, and ability to communicate professionally with clients and employees of RCCS.
- Must be competent and comfortable with MS Word, Excel, and PowerPoint. Experience working in MS Access is preferred.
The physical demands described are representative of those that must be met by an employee to successfully perform the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This position requires full range of body motion including manual and finger dexterity and eye-hand coordination. The position additionally requires standing/sitting for extensive periods of time. Occasional lifting and carrying items weighing up to forty (40) pounds may be required. Requires corrected vision and hearing to normal range.
The work environment characteristics described are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Work is performed in an office environment involving frequent interaction with staff, clients and the general public.