ThedaCare

Medical Billing and Coding

• Reviews and/or assigns CPT and/or diagnosis codes (ICD-10-CM, including HCC risk adjustment) for primary care and/or specialty clinic services (E&M, office procedures, inpatient hospital rounding, OB services, outpatient general practice procedures, etc.) with a high degree of accuracy.
• Performs documentation reviews with the use of department auditing tools, shares results with providers and auditing team, and identifies educational opportunities.
• Collaborates with providers, clinical team members, and/or other departments when completion or clarity is needed within the medical record to accurately complete coding functions.
• Manages and maintains coding inventory responsibilities related to payer denials and claim edits to ensure timely reimbursement for services provided.
• Researches payer policies.
• Manages and maintains operational coding functions to ensure charge capture of all billable services.
• Performs world class service to our customers, responding timely and professionally to inquiries.

Coder, Clinic – II

Recruitment

• Assists the provider recruiters by coordinating the logistics of the recruitment process from the start of search through placement of newly hired physicians and advanced practice clinicians.
• Serves as a liaison between new providers and internal departments through the onboarding process.
• Develops and maintains an effective working knowledge of physician employment agreements, employment process, offer packages, compensation, and benefits to answer candidate’s questions as needed.
• Assists the provider recruiter with the facilitation of the site visit for the provider candidate and spouse/significant other including making arrangements for travel, lodging, and meals, and developing itineraries for physician and spouse and providing transportation as needed.
• Coordinates the completion of required documentation for background checks, license verification, drug screening and other screening as needed.
• Assists the physician candidate in the relocation and reimbursement process.
• Maintains current open physician and APC position list and provides monthly updates as needed.
• Assembles and distributes marketing materials for provider recruitment.

Provider Recruitment Specialist

Accounts Receivable

• Submits billing to the appropriate party and follows-up for adjudication and payment of individual claims
• Communicates with insurance and other payers, patients, guarantors, family members, and/or other medical staff for status of individual claims to manage accounts receivable
• Performs comparative analysis for accuracy of bill before submission to appropriate parties (i.e., charges, subscriber data, diagnosis/procedure codes, and late charges)
• Processes claims in a timely manner according to contracts, regulations, department standards, and form requirements
• Generates phone calls to all parties to check status of unprocessed, unpaid, or rejected claims ensuring accurate and timely reimbursement
• Processes variety of correspondence from all parties taking appropriate steps to expedite timely resolution of claims payment
• Verifies insurance/payer and patient demographic information for accuracy of data collected at time of registration when appropriate
• Inputs verification data to complete in-house claims generation of billing forms
• Re-bills accounts when new information is received requiring account updates with appropriate demographic and third party information to ensure payment
• Updates patient record to indicate changes made
• Reviews internal and external reports for claims status

Coder, Clinic – II

Provider Recruitment Specialist

Accounts Receivable Specialist