Professional Coder/Billing Specialist

Summary:

Under limited supervision this position reviews medical record documentation and helps ensure the diagnosis and procedure codes are applied correctly during the medical billing process, which includes abstracting the information from documentation, assigning the appropriate codes, and creating a claim to be paid by insurance carriers. The standard codes will be assigned using CPT, ICD-10-CM and HCPCS Level II classification systems. Incumbent will submit claims in accordance with governmental regulations and private payer policies, follow-up on claim statuses, provide resolution of claim denials, submit appeals, post payments, adjustments, and support collections management.

Essential Duties and Responsibilities

• Reviews medical documentation and assigns most specific standard codes using CPT, ICD-10-CM and HCPCS Level II classification systems.
• Understands the coding systems’ corresponding guidelines and what codes are accepted by which insurance plans, which government and payer regulations to follow, and how to be compliant while coding.
• Follows official coding guidelines to review and analyze health records. Maintains compliance with both external regulatory and accreditation requirements, and with State and Federal regulations. Extracts pertinent data from the patient’s health record, and determines appropriate coding for reports and billing documents.
• Provides training, education, and support to providers and professional staff and recommends the appropriate codes that follow federal mandates and compliance. Utilizes the coding query process to providers to request missing information. Corrects records with inconsistent information and/or containing discrepancies.
• Performs routine audits independently and participates in performance improvement. Participates in coding compliance plans, research and analysis, benchmarking, financial and strategic planning, and other requested project(s).
• Submits claims in accordance with governmental regulations and private payer policies, follow-up on claim statuses, resolution of claim denials, appeals submission, posting of payments and adjustments and collections management.
• Conforms to safety policies and general housekeeping practices.
• Demonstrates sound work ethics, flexible, and shows dedication to the position.
• Demonstrates a positive attitude, is respectful, and possesses cultural awareness and sensitivity toward clients and co-workers.
• Keeps customer service and the mission of the organization in mind when interacting with all clients, co-workers, and others.
• Expected to be prepared to start shift on time, meet attendance standards, and work the hours necessary to perform the essential functions of the job.
• Employees are expected to embrace, support and promote the core values of respect, integrity, trust, compassion and quality which align with Chugachmiut’s Mission and Vision through their actions and interactions with all patients, staff, and others.
• Conforms to Chugachmiut policies, strict employee confidentiality, and HIPAA regulations.
• Performs other duties as assigned or required.

Work Environment:

Chugachmiut employees strive both for excellence in the services they provide and, through our Employee Values Statement, to serve with integrity. This requires working in an environment where blame and shame are not tolerated. Instead, we use quality improvement tools such as Lean Administration and Training With-in Industry for managing processes. Effective communication is essential and employees must learn how to share problems with fellow employees with a purpose of solving them.

Customer Service:

• Greets both internal and external customer with eye contact and a smile.
• Solicits and responds to feedback for customer satisfaction.
• Attendance is regular and on time without excessive absences.
• Presents self and Chugachmiut by displaying professional behavior and appearance.
• Practices and promotes effective collaboration to accomplish the goals of the team.
• Supports the Mission and values of Chugachmiut; creates solutions that add value to the operations of Chugachmiut.

Physical Environment:

The following demands are representative of those that must be met by an employee to successfully perform the essential functions of this job. The position requires the ability to sit for long period of time. The position requires: normal range of hearing and eyesight, eye-hand coordination and manual dexterity to operate office equipment such as computer keyboard, photocopier, telephone and calculator. Employee may be required to lift approximately 30 pounds. Travel to remote locations by boat, snowmobile, ATV or small plane is required and employee must be willing and able to travel.

Hours of Work:

Hours of work are Monday to Friday, 8:30a.m. to 5:00 p.m., with one hour for lunch. Chugachmiut maintains a drug and alcohol and/non-smoking work environment.

Qualifications:

• An Associate’s Degree in Health Information Management or progressively responsible professional/exempt work experience may be substituted
• Two (2) years of medical coding experience. An equivalent combination of relevant education and/or training may be substituted for experience
• Any one of the following certifications: Certified Coding Specialist (CCS), Certified Coding Specialist-Physician (CCS-P), or Certified Professional Coder (CPC)
• Experience working in an Alaska Native Tribal Health billing environment is preferred

Knowledge, Skills and Abilities:

• Knowledge of medical terminology, abbreviations, anatomy and physiology; major disease processes and pharmacology
• Knowledge of CPT, ICD-10-CM, and HCPCS Level II coding guidelines
• Knowledge of coding conventions and rules established by the American Medical Association (AMA), the American Hospital Association (AHA) and the Center for Medicare and Medicaid (CMS), for assignment of diagnostic and surgical procedural codes
• Knowledge of ethical coding principles and revenue cycle activities
• Knowledge and successful navigation of the varying rules and regulations applying to the healthcare industry, including HIPAA, False Claims Act, Fair Debt Collections Act, and Stark
• Knowledge and understanding of the life cycle of a medical billing claim and how to improve the revenue cycle
• Knowledge and expertise in effective claim follow-up, patient follow-up, denial resolution and collections management
• Knowledge of the principles and practices of medical file and record management
• Knowledge how to submit claims in accordance with governmental regulations and private payer policies
• Skill in reading medical records, and finding and resolving documentation discrepancies
• Skill in operating a personal computer and utilizing a variety of software applications
• Skill in understanding medical/surgical coding procedures and protocols
• Skill in linking diagnosis to services and applying appropriate codes to diagnosis, procedures and supplies
• Skill in using analytical and research modalities skills to define and solve problems
• Skill in interpreting and applying ethical coding standards, federal and state laws and regulations; rules; policies and procedures; and professional practice standards for health care organization coding compliance program activities
• Skill in assessing and prioritizing multiple tasks, projects and demands
• Skills in team building and mentoring
• Skill in reviewing chart documentation and selecting specific codes for billing
• Ability to assume responsibility and work independently
• Ability to initiate and maintain professional work and community relationships
• Ability to communicate effectively (both orally and in writing)
• Ability and willingness to travel frequently to all Chugachmiut regional clinics which are only accessible by air or water.
• Ability to be adaptable and flexible