Description

Location: SGMC Patient Financial Services
Department: REVENUE CYCLE MEDICAL GROUP
Schedule: Full Time, 8 HR Day Shift, 8-5

POSITION SUMMARY

Reviews billed charges professional services to ensure quality and integrity are met according to compliance and official coding guidelines. Meets with management to report any discrepancies and provide education to providers in order to improve coding practices. Monitors coders accuracy and provide education to coders when needed. Effectively communicates with providers to clarify documentation issues and/or discrepancies. Interact with other team members of the revenue cycle and provider clinics. Tracks coding issues and reviews coding inaccuracies to include insurance denials to highlight areas of improvement. Responsible for education for newly hired physicians/providers to include re-education when necessary. Must be able to research LCD, NCDs along with the ability to provide proof of medical necessity. Maintains professional knowledge by attending educational workshops, webinars and other related educational sources. Serves as a subject matter expert in coding and coding related inquires for documentation, denials and billing. Must have highly effective and professional written and verbal communication skills. Knowledge of legal, regulatory and policy compliance issues regarding medical coding, billing, and documentation. Must be able to meet competing deadlines, be highly organized, goal driven, and work well with others. Assists in monitoring and reviewing of denials for education opportunities for Providers, clinic staff, and billing staff. Performs all other duties assigned.

KNOWLEDGE, SKILLS & ABILITIES

• Certified Professional Coder (CPC) Required.
• Certified Professional Medical Auditor preferred, experience may substitute certification.
• Experience in provider education and/or auditing preferred.
• High School graduate or equivalent.
• Knowledge of anatomy and physiology, medical terminology, ICD-10, HCPCS, and CPT required.
• Experience in abstracting E/M and CPT codes. Must have Multispecialty/Complex coding experience.
• Good communication skills essential.
• Medical Office setting experience preferred.
• Time management skills.
• Demonstrates initiative to provide quality of services and improve efficiencies.
• Proficient in Microsoft Office, especially Excel and Teams.

WORKING CONDITIONS - ADA INFORMATION

May spend long hours working at computer terminal. Must be able to see and read names, numbers, and colors. Subject to high stress levels.