OVERVIEW OF POSITION:
Responsible for participating in the implementation of the organization’s Coding Proficiency program. Performs medical chart audits for Evaluation and Management and ICD-9 coding and documentation. Interfaces and disseminates audit results to clinicians and management.
Performs medical chart audits meeting minimum productivity standards.
Educates clinicians on specific coding issues found in senior HMO pre-audits.
Submits and follows up on query forms to clinicians based on “inferred” chart audit data.
Submits weekly audit totals to Coding management.
Performs claims analysis for appropriate CPT and ICD-9 coding.
Identifies CPT unbundling in claim submissions.
Uses coding knowledge to work the claim system edits.
Performs Coding analysis of claims denials.
Reviews TES edits for coding analysis.
Works with Claims management and IPA / contracted clinicians on claim edit resolution.
Stays abreast of industry coding and compliance issues.
Participates in coding / auditing discussions to ensure best practice efforts and processes are implemented ensuring maximum reimbursement through appropriate coding.
Attends Coding program monthly meetings.
Performs additional duties as assigned.
One or two years of post-high school education or a degree from a two-year college.
Coding certification through AAPC or AHIMA required.
3 years medical billing or health care experience.
IDX BAR experience.
Allscripts / Enterprise experience.
KNOWLEDGE, SKILLS, ABILITIES:
Computer literate with medical billing software.
Proficient in Word, Excel, PowerPoint, Multi-media projector.
Knowledge of CMS coding guidelines.
Excellent verbal and written communication skills in the English language.
Must be able to work independently to carry out work efforts.
Bilingual / Spanish preferred.