- Review outpatient vascular procedure and wound care documentation for accuracy, completeness, and consistency.
- Identify documentation gaps and query clinicians to clarify diagnoses, procedure details, medical necessity, and coding-relevant elements.
- Check documentation against payor requirements for complex procedures and wound care products.
- Confirm medical records demonstrate medical necessity and clinical appropriateness.
- Track denial and documentation deficiency trends with revenue cycle, pre-authorization, and clinical operations teams.
- Educate providers and clinical staff on documentation best practices, diagnosis specificity, medical necessity, and procedure details.
- Review payor Medical Coverage Guideline updates with clinical operations leadership and coordinate required changes.
- Collaborate on EMR templates, macros, and related builds for medical necessity and billing requirements.
- Participate in monthly denial review meetings and help develop solutions.
- Maintain the confidentiality and security of Protected Health Information in accordance with HIPAA.
EHRHIPAA