Description

JOB CONTENT

Position Summary:

(Overall purpose of this position)

• Under general supervision, reviews, analyzes and assures the final diagnoses and procedures as stated by the practicing providers are valid and complete. Accurately codes all procedures for providers to ensure proper reimbursement. Accurately review Coding Denials for previous payments, and guidelines to support claims that were processed correctly. True Denials will be actioned upon in accordance with Insurance, State, Local and Federal Guidelines set forth, referencing Insurance Provider Manuals for maximum reimbursement.

Essential duties and responsibilities which must be performed to carry out the position purpose summarized above:

(The following description is a general representation of the key duties and responsibilities of this position. Other duties may be assigned, as required.)

1. Reviews charges for accurate coding. Ensures appropriate application of CPT and ICD codes in accordance with the most recent Insurance, Federal, State and Local Guidelines.
2. Utilize an internal FEE Schedule Procedure in accordance with the Neighborhood Family Practice Policy for accurate coding
3. Review and maintains Pre AR-Claim and Coding Edits in accordance with NCCI, LCD and NCD Coverage Determination in the Charge Review stage in collaboration with the RCM Billing Supervisor.
4. Ensures timely submission of all charges by monitoring priority instances of aging in accordance to set Guidelines.
5. Prepare reports for clinical staff identifying unbilled charges due to inadequate documentation.
6. Identify coding issues and bring to the attention of the Revenue Cycle Manager for a collaborative development of training content.
7. Identify education needs for providers based on Pre-AR and Claim Denial/Follow Up trending and special projects. Keep logs and copies of current Insurance, State, Local Federal guidelines to communicate with Revenue Cycle Manager on a weekly basis.
8. Maintain information in a confidential manner.
9. Cross train with other staff on essential business office functions and
10. Provide support on Medical, Behavioral Health and Dental Coding Denials and Follow Up, Identify trending and areas for provider education and process improvements. Responsible for creating an appeal process within the department.
11. Provide customer service to patients and internal customers when needed on the department hunt group.
12. Maintain a desk manual with how to instructions including print screens that can be utilized to cover responsibilities during vacation or sick leave.
13. Perform special projects as assigned by Revenue Cycle Manager.
14. Participate in continuous learning; stay apprised on updated coding information and changes in coding and/or regulations.
15. Participate in OCHIN EPIC Billing Workgroup. Act on information and communicate changes as appropriate.
16. Maintain professional relationships with providers and/or staff

Perform other duties as assigned.

• Will contribute to collaborating with the Revenue Cycle Manager on Provider Education Topics to set strategies for future delivery of content.

Qualifications

Qualifications:

1. Specific knowledge, training or skills required to perform the duties of this position. Specific concepts, courses, training programs or required certifications: To perform this position successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skills and abilities required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
2. Familiarity with governmental (FQHC, Medicare A, B, C, & D, and Medicaid) and healthcare fiscal regulations, billing, coding, and reporting.
3. Familiarity with Federally Qualified Healthcare Center standards of Medical, Behavioral Health and Dental Coding is beneficial to
4. Possess analytical and problem-solving skills for coding denial review, appeals, and medical necessity policies.
5. Computer proficiency: EPIC related billing software and Microsoft Office Suite
6. Certified Professional Coder (CPC) AAPC or Certified Coding Specialist (CCS), AHIMA credential required. 5 years of experience with CPT, HCPCS and ICD10CM is beneficial to the role.
7. High school diploma or GED.
8. Essential Physical Demands and Working Environment:
9. The physical demands and work environment described below are representative of those that must be met by an employee to successfully perform the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
10. Ability to see, communicate, hear, and utilize electronic communication devices.
11. HIPAA compliant office work environment
12. Limited local and overnight travel.

Previous experience that is necessary background to qualify for this position:

• Minimum of five years of physician and hospital billing experience with specific knowledge in medical terminology and CPT, CPT II, HCPCS and ICD10CM coding.

REPORTS TO AND EVALUATED BY: Revenue Cycle Manager