The Medical Billing and Coding Processor function is a primary source for data and information used in health care today, and promotes provider/patient continuity, accurate database information, and the ability to optimize reimbursement. The coding function also ensures compliance with established coding guidelines, third party reimbursement policies, regulations and accreditation guidelines.
DUTIES AND RESPONSIBILITIES
* Performs a comprehensive review for the record to assure the presence of all component parts such as: patient and
record identification, signatures and dates where required and other necessary data in the presence of all reports
which appear to be indicated by the nature of the treatment rendered.
* Support the Senior Medical Billing and Coding Specialist to respond to audit findings and make applicable coding
additions or corrections
* Registers and analyzes claims in the EMR system, including insurance verification and charge entry. Tracks and
requests outstanding claims for assigned departments/facilities
* Reviews Medicare Local Coverage Determination (LCDs) and Medicare bulletin updates
* Utilizes the EMR system to run required daily/monthly/quarterly reports on claims entered.
Accepts assignments from management and maintain open communication with their manager to resolve quality
and production issues
High School diploma or GED required/Associates’ degree preferred, Minimum of 3-5 years’ experience using ICD-9-CM, Volumes 1- 3, CPT, HCPCS, and IHS coding conventions. CPMA, CFPC, CPC-P or CPC certification is required
KNOWLEDGE & EXPERIENCE REQUIRED BY THE POSITION
Complete knowledge and understanding of UHC PM and EMR workflows