Coding Representative
Patient Business Services - Torrance, CA

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Job Title: Coding Representative Location: Torrance, CA

Employee Type: Full Time Department: Billing

Company: AMR-PBS Reports to: Coding Supervisor

Base Pay: Based on experience Req#: 16825

POSITION SUMMARY BRIEF:

The Coding Representative is responsible for the accurate and timely billing of ambulance transports for one or more geographical areas while maintaining minimum quality and productivity standards set for Coding Representative. The incumbent is expected to determine diagnosis and levels of service based, on information provided on the Patient Care Report (PCR) and to accurately bill using the appropriate ICD-9/Condition Codes. The incumbent assumes full coding and file maintenance responsibilities for repetitive patients.

DUTIES:

Managerial

Manage own time and work assignments effectively.

Seek advice/feedback in terms of priorities or issues when necessary.

Technical

Review and/or determine the appropriate primary source of payment.

Determine the Level of Service to be billed, based on supporting documentation on the PCR and/or in the Computer Aided Dispatch (CAD) notes, including but not limited to, designating Advanced Life Support (ALS), Basic Life Support (BLS), Wheelchair, or Specialty Care Transport (SCT) /Critical Care Transport (CCT).

Assign appropriate insurance carrier by utilizing the billing address and/or payor prefix.

Assign appropriate modifiers, based on origin and destination of trip.

Assign proper condition codes/ICD-9 codes into the Accounts Receivable Billing System.

Create narrative in Accounts Receivable Billing System to document status of trip for use in claim appeal process.

Ensure that charges are billable to a particular commercial/government payor based on the payor’s criteria.

Assign ancillary procedures to charges when applicable based on payor specific guidelines, (e.g. I.V. treatment and oxygen).

Identify “quoted rates” as specified in PCR and/or CAD notes for private pay patients and bill accordingly.

Forward all credit card payments to Cash Posting when identified in PCR and/or CAD notes.

Run “Journal Entry” report daily to verify accuracy of data entered.

Review, verify and correct reports, (e.g. “Journal Entry” and Electronic Claim Transmission”) as necessary.

Complete trip messages field and/or ANSI screen in Accounts Receivable Billing System.

Create and maintain medical record files for repetitive patients including but no limited to, physician certifications and patient assessments.

Verify that a physician certification or a letter of medical necessity has been received and contains the required information/signatures.

Scan all repetitive patient documentation and store on a shared drive within PBS.

Maintain data base containing all repetitive patient information.

Manage expiration dates of patient assessments and Physician Certification Statements (PCS).

Notify management, PBS and AMR Operations, of the expiration of patient assessments and PCS’s.

Forward to a “Collection Plan” and request additional information on claims that do not have the required physician certification or a letter of medical necessity.

Request authorization numbers from Medicaid as necessary.

Add appropriate secondary modifiers to claims, (e.g. GY, GZ).

Complete special projects as assigned.

Perform other duties as required.

Interpersonal

Work in a spirit of teamwork and cooperation.

Convey a sense of competence and commitment.

Use initiative to learn new skills, enhance personal knowledge and improve communications.

Demonstrate an ability to work well with team members,

Communicate a willingness to help others succeed.

Mentor peers to meet production and quality standards.

Share workspace and resources as necessary.

Knowledge

Medical transportation processes and insurance terminology.

Understanding of the terminology on a PCR, Hospital Face Sheet, and/or a CAD Sheet.

Medical terminology and Insurance terminology.

Process of signature and paperwork compliance.

Payor-specific requirements for one or more geographical areas.

Definitions of and distinctions between ALS/BLS/SCT/CCT/Wheelchair levels of service.

ICD-9 coding/condition codes and procedure codes.

HIPAA requirements.

Skills

Proficient in the Accounts Receivable Billing System and Internet tools, (e.g. Internet mapping programs, eligibility websites, address search engines).

Communicate effectively, (both orally and in writing) in English.

Abilities

Pass and sustain new-hire and department-specific testing, (e.g., data entry and department-specific aptitude test).

Be flexible with shifting daily priorities.

Meet deadlines working within tight time constraints.

Handle large volumes of work.

Document appropriate narratives in Accounts Receivable Billing System for use in claim appeal process.

Determine medical necessity of ambulance trips and the need to be transported from facility to facility based on information obtained from the PCR, internal spreadsheets and/or Internet.

Determine when the use of a secondary modifier is necessary.

Process clean claims for one or more geographical areas.

Exceed minimum quality performance standards by three percentage points or more, consecutively for a minimum of six months, and maintain those standards for a minimum of four out of every rolling six month time period thereafter.

Meet or exceed all established standards for productivity.

Minimum Requirements:

Education/Experience:

High School Diploma or GED required; Associates Degree or certificate of completion from a coding and billing school preferred. Minimum two (2) or more years previous medical billing experience required, ambulance billing experience preferred.

Physical Requirements:

Occasionally:

Light lifting (paper files, office equipment)

Working Environment:

Occasionally:

Mandatory and/or voluntary overtime

Constantly:

Office environment (cubicles, enclosed offices)

Equipment Used:

Occasionally:

General collating equipment, telephone

Frequently:

Copy machine, scanners, fax machine

Constantly:

Personal computer

We are an EOE/AA employer

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