Monitors reimbursement coding activities on clinical services including securing, maintaining and distributing current coding information and implementing changes. Updates clinical systems procedures and diagnosis codes in databases.
Essential Job Functions:
1. Develops new coding policies, procedures, and fee slips and ensures physician are using appropriate codes.
2. Reviews samples of coded services for accuracy and completeness; meets with providers to make required changes.
3. Codes services of questionable or new items, and reviews proper coding with providers and staff
4. Reviews reimbursement from third-party payers to ensure payment through proper use of codes.
5. Notifies and trains providers and staff of significant changes in CPT and ICD codes.
6. Maintains clinical information system diagnosis code master files to include identifying inappropriate codes and informing medical staff.
7. Evaluates and develops new entries based on the latest coding publications.
8. Works with medical staff to resolve coding issues and associated problems.
9. Maintains fee schedules for Medicare, fee for service and health maintenance organizations.
10. Monitors Medicare reimbursements and maintains files. Assures information is available for review.
11. Participates in educational activities.
12. Performs other duties as assigned by supervisor.
Marginal Job Functions:
Required Knowledge, Skills and Abilities:
1. Knowledge of clinic approved/international coding schema.
2. Knowledge of third party fee profiles and reimbursement requirements.
3. Advanced knowledge of computer coding applications.
4. Ability to identifying and resolving complex coding problems.
5. Skilled in exercising initiative, judgment, discretion and decision-making to achieve organizational objectives.
6. Ability to establish and maintain effective working relationships with patients, medical staff and public.
7. Ability to examine insurance documents for accuracy and completeness.
8. Ability to prepare insurance records in accordance with detailed instructions.
High School Diploma or Equivalent
Major (if required):
Minimum of three (3) years of experience with coding and/or reimbursement activities, including experience of coding for medical practices.
1. Associate's Degree.
2. Experience in reading medical charts and in assigning the correct diagnosis (ICD-9), procedure (CPT), and supply (HCPCS Level II) code for a wide variety of clinical cases and services.
Is this a safety sensitive position (are applicants potentially subject to drug testing)?
Does this position require a criminal background screening?
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