Description

Purpose Summary:The Revenue Cycle Management (RCM) Medical Coder I protects the financial value of RCM clients work by providing expert review and coding of clinical documentation. As an integral part of our RCM team, the position serves in a cross-functional, fast-paced environment in order to meet performance and quality assurance benchmarks. Essential duties include accurately assigning and sequencing procedure and diagnosis codes for insurance reimbursement as well as data entry of transactions along with communication with team regarding outstanding issues.

Responsibilities:

• Analyzes and interprets documentation from medical records to ascertain complete and accurate diagnosis and procedure coding in an office setting.
• Abstracts and validates required data elements into the coding and billing systems.
• Communicates with providers via Task for missing documentation or questions regarding documentation and offers guidance and education when needed.
• Use coded data, and/or medical records to enter charges into MedEvolve PM or other software applications used by RCM client.
• Determines principle diagnosis(es) and procedure(s) utilizing updated Medicare coding guidelines and other references.
• Enters patient demographics including insurance information into the billing system, if applicable
• Verify insurance coverage in MedEvolve PM or other software applications used by RCM client.
• Enters diagnosis and procedure codes into MedEvolve PM or other software applications used by RCM clients to generate a bill, as appropriate.
• Identifies and codes all applicable invasive procedures utilizing the encoder and abstracting system.
• Utilizes the chart management system as required by task and responsibility.
• Post private payments associated with superbills into MedEvolve application and/or other software applications used by RCM client.
• Understands RCM lifecycle, including the process of each claim and how this position directly impacts the process and other steps within the process
• Demonstrate understanding of billing procedures through verifying accuracy of all patient encounter forms submitted for processing or billing, including modifiers, bundled codes, (global, CCI edits, etc..)
• Keep current on informational changes in Coding and Billing procedures
• Meet benchmarks for data entry accuracy.
• Communicate/answer questions regarding coding
• Other duties as assigned

Key Measures:

• Transform physicians documentation into CPT and ICD codes accurately
• Verify patient insurance eligibility
• Reduction of A/R
• Timely interactions with internal team to support coding denials and outstanding claims

Qualifications

Qualifications:

• Certified coder: CPC coding credentials
• Minimum 0-3 years of relevant experience
• Possess a sound knowledge of medical coding rules, regulations, and compliance utilizing ICD 10, CPT and HCPC.
• Excellent communication skills: communicate effectively with management, clinical and business staff, and physicians
• Ability to deal with a number of tasks simultaneously
• Strong attention to detail
• Intermediate computer skills
• Understands the importance of maintaining confidentiality; able to maintain confidentiality under HIPAA standards
• Must have the ability to exercise a high degree of diplomacy and tact; excellent customer services skills
• Must be highly flexible; able to accommodate changing needs of the department
• Must be a self-starter, motivated and have the ability to multi-task
• Training and/or experience with computer data entry
• Knowledge of medical terminology required within the specialties assigned
• Ability to understand and follow instructions

Physical Elements and Work Environment:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Regularly required to sit, talk, and hear
• Occasionally required to stand and walk
• The noise level is usually moderate