Job Title: Coding Representative - Level 1
Date: February, 2013
Reports To: Coding Supervisor
Location:: Modesto, CA
POSITION SUMMARY BRIEF:
The Coding Representative - Level 1 (Government and Non-Government) is responsible for the accurate and timely billing of ambulance transports for one geographical area, while maintaining the minimum quality and productivity standards set for the Level 1 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 codes.
Manage own time and work assignments effectively.
Seek advice/feedback in terms of priorities or issues when necessary.
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 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 report, (e.g. “Journal Entry” and “Electronic Claim Transmission”) as necessary.
Complete trip messages field and/or ANSI screen in Accounts Receivable Billing System.
Verify that a Physician Certification or a Letter of Medical Necessity has been received and contains the required information/signatures.
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).
Perform other duties as required.
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.
Share workspace and resources as necessary.
Medical transportation processes.
Language and terminology on a PCR, Hospital Face Sheet, and/or a CAD Sheet.
Medical terminology and insurance terminology.
Understanding of the process of signature and paperwork compliance.
Payor-specific requirements for one geographical area.
Definitions of and distinctions between ALS/BLS/SCT/CCT/Wheelchair levels of service.
ICD-9 coding/condition codes and procedure codes.
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.
Pass and sustain new-hire and department-specific testing, (e.g. data entry test and department-specific aptitude testing).
Be flexible with shifting daily priorities.
Meet deadlines working within tight time constraints.
Handle a large volume 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 geographical area.
Meet or exceed all established standards for productivity and quality.
High School Diploma or GED required; Associates Degree or certificate of completion from a coding and billing school preferred. Minimum one (1) or more years previous medical billing experience preferred, ambulance billing experience preferred.
Light lifting (paper files, office equipment)
Mandatory and/or voluntary overtime
Office environment (cubicles, enclosed offices)
General collating equipment, telephone
Copy machine, scanners, fax machine
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