Strength Through Diversity
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- Manages and accurately codes outpatient encounters diagnosis, procedures and/or modifiers that are supported by the health record in accordance using ICD-10-CM/PCS, CPT and HCPCS coding conventions.
- Abstracts, codes and assigns necessary demographic and clinical data elements required for outpatient records into Epic EMR
- Performs specialized coding services for outpatient medical office visits and infusion services. Reviews physician coding and provide updates.
- Queries and/or submits request to the physician for additional information or clarification of diagnoses, co-morbid/secondary conditions, and procedures. Assures coding practices fall within established compliance guidelines.
- Assists with reviews of billing denials from reference labs and other sources.
- Audits medical records to ensure proper coding completed and to ensure compliance with federal and state regulatory bodies.
- Maintains compliance standards in accordance with the Compliance policies and the Code of Conduct. Reports compliance problems appropriately. Reviews encounter forms for accuracy.
- Posts necessary charge codes for billing in Eagle. Runs and works missing charges, edits, denial lists and processes appeals.
- Provides comprehensive pre-billing management to facilitate cash flow. Tracks, quantifies and reports on denied claims.
- Directs and assists with responses to problems or questions regarding medical necessity for ordered drugs and procedures.
- Analyzes claims system reports to ensure underpayments are correctly identified and collected from key carriers. Reviews and resolves billing issues with medical necessity and provides recommendations.
- Meets with practice management, leadership and/or physicians on a scheduled basis to review current billing and coding concerns.
- Mentors less experienced coding and billing staff and assists Billing Manager/Revenue Cycle Manager in staff training.
- Maintains a thorough understanding of medical terminology through participation in continuing education programs to effectively apply ICD-10-CM/PCS, CPT and HCPCS coding guidelines to inpatient and outpatient diagnoses and procedures.
- Other duties as assigned
- Associates Degree or high school diploma/GED
- Certification: CPC strongly preferred
- 5 years experience in dental and medical billing or health claims, with experience in Dentrix and IDX billing systems in a health care or insurance environment, and familiarity with ICD/CPT coding.
- Excellent organizational skills
- Excellent communication and customer service skills
- Knowledge of medical terminology and anatomy
- Strong attention to detail and ability to multitask
- Excellent calculation, verbal and communication skills
- Strong ability in analysis and research