Classify medical data from patient records to assign ICD-10-CM and CPT codes for primary and multi-specialty physician billing. Reviews clinical billing for coding and billing accuracy. Review claim denials for coding-related issues and assist CBO collectors with resolution.
Demonstrate knowledge of reimbursement guidelines and changes in payer policy. Provide guidance to clinical staff and providers where necessary. Serves as a resource for clinics on coding issues and questions as needed.
May supervise an individual billing team of non-certified billers and collectors. Performs research on coding changes and payer policies on an ongoing basis. Description: Qualifications High School Diploma or GED (Required) Vocational / Technical Degree (Preferred) 2 year / Associate Degree in Health Information Management (Preferred) Work Experience 2 - 3 years Diagnosis and CPT coding in a clinic, business, or revenue cycle environment or any combination thereof.
(Preferred) 2 - 3 years Broad knowledge of medical terminology and anatomy. (Preferred) Licenses and Certifications Required Certifications/Licensures: Coding Certification (CPC or CCS) Preferred Certifications/Licensures: CPMA
CODING
Review medical records to assign ICD-10-CM, CPT, and HCPCS Level II codes and modifiers for accurate primary and multi-specialty billing. Provides analysis and education on coding trends and changes in payer policies to providers and staff. CODING REVENUE CYCLE
Review claim denials for coding issues, interpret payer guidelines, and assist insurance collectors with resolution for proper reimbursement. Prepare or assist with appeals process as necessary. CODING PRODUCTIVITY: Performs coding duties accurately and timely to ensure appropriate reimbursement and maintain revenue flow continuity.
Additional Duties Adheres to the hospital and departmental attendance and punctuality guidelines. Performs all job responsibilities in alignment with the core values, mission and vision of the organization. Performs other duties as required and completes all job functions as per departmental policies and procedures.
Maintains current knowledge in present areas of responsibility (i.e., self education, attends ongoing educational programs). Attends staff meetings and completes mandatory in-services and requirements and competency evaluations on time. Demonstrates competency at all levels in providing care to all patients based on age, sex, weight, and demonstrated needs.
For non-clinical areas, has attended training and demonstrates usage of age- specific customer service skills. Wears protective clothing and equipment as appropriate.