Reviews and edits charge tickets, ensuring proper use of diagnosis and procedure codes for accurate billing and maximum reimbursement. Completes charge tickets by applying modifiers, CCI edits, etc., and batches according to department policy in preparation for data entry. Reviews and codes from electronic charge interfaces in lieu of paper charge tickets.
1. Reviews electronic coding queues for charges presented via an interface from ancillary applications.
2. Receives charge tickets from the DP clerk, after tickets are date stamped (in batch) and sorted according to specialty.
3. Confirms accurate patient demographics on each ticket including MSR#, patient #, insurance information, etc. according to department policy.
4. Verifies referring physician and rendering physician provider #'s are present.
5. Applying knowledge of coding rules, verifies the proper use of the following items and makes appropriate corrections:
· Payor specific billing guidelines
· ICD9 diagnosis codes
· CPT4 E&M and procedure codes
· HCPCS codes
· CCI edits
· Multiple surgery guidelines
· DMERC guidelines
· Rural Health guidelines
Look-up and verification of some codes using software and/or coding books is required.
6. Highlights appropriate fields on each ticket to prepare for charge entry.
7. Processes charge tickets according to department policy. Reviews and ensures appropriate waivers are complete (when attached to the charge tickets) prior to posting the correct modifier or miscellaneous text.
8. Distributes tickets or copies of tickets to various areas of the department as dictated by department policy (i.e., Charity care, special accounts, MVA, L&I, etc.).
9. Responsible to stay current with billing guidelines and reimbursement rules and regulations.
10. Provides feedback to providers regarding incorrect coding according to department policy.
11. Works with medical staff to resolve coding issues and related problems.
12. Works PCA edit reports and releases batches per department protocol.
13. Assists with charge ticket revisions by reviewing appropriate tickets for accuracy of CPT and ICD codes as requested.
14. Completes weekly production logs for department statistical reporting.
High School graduate or equivalent. CPC or other coding certification preferred.
Proficient in the performance of basic math functions. Possesses basic computer (e.g., spreadsheets, word processing) skills. Knowledge of ICD-9, CPT coding, medical terminology, and insurance billing preferred. Must be a team player. Maintains a positive, resourceful attitude toward achieving overall department and clinic goals.
This is not intended to be an all-inclusive description; just a summary of some of the duties required.