Job Summary
This position assigns appropriate billing codes for acute care, periop, or outpatient unit(s), clinic(s) or medical office(s) system-wide. Evaluates medical records, provider notes and dictation to determine appropriate procedure codes to assign to patient records and bills. Uses coding software and the companys Charge Description Master (CDM) to create billings and charges for insurers, government agencies and other payors. Researches coding for non-standard procedures and assigns codes in accordance with nationally recognized coding guidelines and company standards.
Essential Functions
Audits daily error reports in both the coding and billing system and makes corrections. Matches, corrects and codes charges that do not drop to billing. Also responsible for working daily monitoring queries that capture errors prior to billing as well as individual requests from the CBO or HIMS. As assigned shares this information with clinical charging staff.
Reviews patient records, dictated report(s), physician/provider notes. Uses a standard listing of procedures/charge codes and/or an automated system with the companys programmed Healthcare Common Procedure Coding System (HCPCS) for all commonly used Diagnosis Related Groups (DRGs).
Researches and assigns codes for non-standard procedures, supplies, equipment or materials.
Researches missing and incompatible records information supplied by medical staff, transcriptionists, suppliers and others. Assures that all appropriate items, procedures and services are recorded and appropriately billed. Acquires medical record completion as required by national coding standards.
Identifies opportunities for improvement in clinical documentation. Provides guidance and education for staff in billing procedures and electronic medical records usage procedures for coding and billing requirements. Maintains a current knowledge of procedural terminology requirements and provides staff with updated information on reimbursement charges and documentation requirements. As assigned, develops and provides education for physicians and staff.
Works with company finance and Charge Description Master (CDM) teams to develop and maintain coding and billing database information and with other point of service charging/coding staff to maintain consistency in practice. As assigned, shares this information with clinical charging staff.
Works as a member of the system team to provide services and achieve goals. As assigned, may manage supply chain functions, scheduling, provide patient services or administrative support.
Minimum Qualifications
High school diploma/GED or equivalent working knowledge.
Requires a level of knowledge normally gained over four or more years of related work in the same type of clinical, medical office or acute care unit. Must be knowledgeable of medical terminology and current regulatory agency requirements for coding and charging for the assigned clinical area, and have a good understanding of reimbursement methodologies. Requires strong abilities in researching, reading, interpreting and communicating, as well as effective interpersonal skills, organizational skills and team working abilities.
Must be able to work effectively with common office software, coding and billing software, and the electronic medical records system.
Preferred Qualifications
Current Procedural Terminology (CPT) coding experience in a similar setting and Certified Coding Specialist (CCS) or Certified Professional Coder (CPC) credentials preferred for some assignments.
Additional related education and/or experience preferred.
