Is responsible for determining accurate codes for physician’s diagnoses and procedures. Keeps up-to-date with the latest medical compliance and reimbursement policies. Reviews medical record information to identify all appropriate coding, ensuring that it is compliant with the latest reimbursement policies and CMS guidelines. Generates invoices to be sent to insurances and to patients. Sorts and files paperwork, handles insurance claims and performs collections duties.
This position will work with the practice patients and clinical teams to accurately and completely code and prepare charges to be sent out for the patient’s visit.
Utilizes EHR for any documentation needed to support coding of a claim
Efficiently assigns ICD-10-CM, CPT-4 and HCPCS codes for surgeries from documentation based on the most current guidelines
Reviews note prepared by physician and ensures that no mistakes are made in those notes
Contacts physician if information is missing and gets the information filled in an/or corrected
Makes sure all medical record files are complete (including timed, dated, and signed)
Assigns modifiers based on payor guidelines
Understands documentation and compliance requirements for assigning of codes
Maintains strictest confidentiality and follows HIPAA guidelines for protecting Protected Health Information (PHI)
Processes and submits electronic claims
Corrects electronic rejection edits
Ensures all NCCI edits are resolved within 2 business days to ensure claims are submitted within 5 days from service date
Prints paper claims as needed
Provides cash quotes for self-pay surgeries
Quotes and collects cash for non-covered procedures and injections
Follows up to see if claim is accepted or rejected
Investigates rejected claim to see why denial was issued
Performs other duties all other duties as assigned
Safety and Infection Control Responsibilities
ESSENTIAL ORGANIZATIONAL BEHAVIORS
Demonstrates behaviors that are consistent with the Medical Center’s Mission and Values
Performs job responsibilities in an ethical, compliant manner consistent with the Medical Center’s values, policies, procedures and code of conduct.
Works well with team members toward a common purpose. Reinforces the efforts and goals of the work group. Supports the team’s decisions, regardless of individual viewpoint.
Demonstrates flexibility in schedules and assignments in order to meet the needs of the Work Unit/Department.
Utilizes, maintains, and allocates equipment and supplies in a cost effective and efficient manner. Improves productivity through proper time management
Seeks feedback from customers and team members in order to identify and improve processes and outcomes.
Qualifications: ESSENTIAL COMPETENCIES, KNOWLEDGE & EXPERIENCE
High School Diploma or equivalent, required
Certificate or Diploma from an Accredited Program in Medical Coding
Current CPC, CPC-A, CCS, or RHIT certification required
Minimum of 1 year of experience in health care
Demonstrates a good working knowledge of medical terminology, human anatomy and coding methodology
Possesses moderate knowledge of Level 1 & 2 modifiers
Ability to examine documents for accuracy and completeness
Detail oriented with ability to identify and resolve problems
Must possess moderate knowledge of NCCI, CCI edits and LCDs and be able to accurately apply regulation knowledge to coding situations
Ability to communicate clearly and work effectively with co-workers
Strong ethics and a high level of personal and professional integrity
Strong analytical skills
An effective communicator at all levels in the organization, with strong oral, written and persuasive skills