Medical Billing and Coding

• May be required to do one or all of the following dependent on the business needs (including but not limited to): Patient demographic data entry
• Obtaining referrals and pre-authorizations as required for procedures.
• Checking eligibility and benefits verification for treatments, hospitalizations, and procedures.
• Reviewing patient bills for accuracy and completeness and obtaining any missing information.
• Preparing, reviewing, and transmitting claims using billing software, including electronic and paper claim processing.
• Following up on unpaid claims within standard billing cycle timeframe.
• Checking each insurance payment for accuracy and compliance with contract discount.
• Calling insurance companies regarding any discrepancy in payments if necessary
• Identifying and billing secondary or tertiary insurances.
• Reviewing accounts for insurance of patient follow-up.
• Researching and appealing denied claims.
• Answering patient or insurance telephone inquiries pertaining to assigned accounts.
• Setting up patient payment plans and work collection accounts.

Medical Billing Specialist

• Process claims to appropriate primary, secondary, and/or tertiary insurance company according to insurance guidelines
• Perform follow-up on unpaid insurance accounts identified through aging reports
• Process appeals when appropriate
• Process refund requests
• Identify trends, and carrier issues relating to billing and reimbursements, report findings to leadership
• Maintain Privacy & Confidentiality of patient information and organizational operations
• Responsible for learning, understanding and following payer guidelines
• Reallocate misapplied payments and adjustments
• Work special assignments when needed

Medical Billing & Collections Specialist

• Ability to comprehend medical record documentation to accurately assign codes for both concurrent and discharged accounts across multiple specialties.
• Meets minimum requirements for production and quality monthly.
• Requires a working knowledge of code sequencing for grouper-related payers with attention to detail to avoid rework and waste with charge capture assessment component.
• Requires understanding and application of M.E.A.T. criteria (i.e., monitoring, evaluation, assessment, treatment) using ICD 10 CM transaction data set to capture diagnoses.
• Analyzes high-risk encounters for accurate and/or missing charges gaps prior to encounter completion (i.e., missing charges from anesthesia, surgery) when manual charge capture occurs.
• Understand complexity of billing requirements and incorporates payer specific trends into day-to-day reviews to reduce “take backs” associated with un-clear, or un-substantiated care rendered.
• Requires excellent coding knowledge of ICD 10 CM, CPT 4, and modifier application, with expectations to maintain certification (i.e., CCS, CPC, RHIT, or RHIA) and apply ICD 10 CM Coding Guidelines specific to both inpatient and outpatient encounters.
• Facilitate modifications to clinical documentation through query interaction to ensure that the information captured supports the level of service rendered, with attention towards chronic conditions, hierarchical condition categories (HCC), and risk adjustment factors (RAF).

Inpatient Coder

• Overseeing the revenue cycle billing processes
• Ensuring the billing team is accurately performing their job duties daily
• Confidently and accurately perform all areas of the billing cycle workflows
• Participate in hiring and training staff
• Monitor patient demographic data entry
• Ensure the billing team is obtaining referrals and pre-authorizations
• Assist the billing team with data entry and ensure 72-hour billing is met promptly
• Assist with MaxRVU billing when the coders are offline
• Review patient bills for accuracy and completeness
• Preparing, reviewing, and transmitting claims using billing software
• Follow up on unpaid claims within the standard billing cycle timeframe
• Report any billing errors to management for additional staff training

Lead Medical Billing Specialist

• Review medical record documentation to abstract and assign diagnoses, procedures, and modifiers
• Provide feedback regarding documentation and coding issues
• Maintain understanding of and ensure compliance with all applicable Official Coding Guidelines
• Participate in coder and provider education including documentation improvement efforts for providers
• Interact with provider, nursing staff and departments as assigned
• Assist in the training and quality assurance of all coding levels
• Strive for strong unit cohesion by working well with other members of the team

DRG Coder IV

• Reviews medical record documentation to abstract and assign diagnoses, procedures, and modifiers for statistical classification and reimbursement purposes.
• Performs various coding assignments under the direction of Coding Management.
• Provides feedback regarding documentation and coding issues.
• Utilizes software applications and coding references to perform coding related tasks.
• Assists in training, mentoring, and quality assurance of Level I and Level II coders as directed by Coding Management.
• Interacts with clinical departments as needed.
• Strives for strong unit cohesion by working well with other members of the team.

Facility Coder III

• Ability to comprehend medical record documentation to accurately assign codes for both concurrent and discharged accounts across multiple specialties.
• Meets minimum requirements for production and quality monthly.
• Requires a working knowledge of code sequencing for grouper-related payers with attention to detail to avoid rework and waste with charge capture assessment component.
• Requires understanding and application of M.E.A.T. criteria (i.e., monitoring, evaluation, assessment, treatment) using ICD 10 CM transaction data set to capture diagnoses.
• Analyzes high-risk encounters for accurate and/or missing charges gaps prior to encounter completion (i.e., missing charges from anesthesia, surgery) when manual charge capture occurs.
• Understand complexity of billing requirements and incorporates payer specific trends into day-to-day reviews to reduce “take backs” associated with un-clear, or un-substantiated care rendered. (i.e., varying modifier assignment for EAPG vs. Non-EAPG payer specificity)
• Requires excellent coding knowledge of ICD 10 CM, CPT 4, and modifier application, with expectations to maintain certification (i.e., CCS, CPC, RHIT, or RHIA) and apply ICD 10 CM Coding Guidelines specific to both inpatient and outpatient encounters.
• Facilitate modifications to clinical documentation through query interaction to ensure that the information captured supports the level of service rendered, with attention towards chronic conditions, hierarchical condition categories (HCC), and risk adjustment factors (RAF).
• Demonstrates an excellent working knowledge of hospital information systems to retrieve data specific information (i.e., order diagnosis, patient type) within a complicated filing schema including non-hospital data (i.e., Media Tab, Office Visits etc)

Facility ED Coder

• Evaluate medical records and provide clinical and surgical abstraction
• Accurately code diagnostic and procedural information
• Consult with medical providers for record clarification
• Ensure compliance with coding rules and regulations
• Compile reports and tabulate data from medical records
• Identify validation edits and ensure accurate coding
• Work independently under regular supervision

Complex Coder, Surgical Cardiology

• Coding of orthopedic office and surgical procedures using CPT, ICD-10, and HCPCS codes.
• Assignment of modifiers to procedures.
• Works closely with physicians and other providers/office staff regarding completeness of office notes and operative reports to ensure accurate coding.
• Serves as a resource and subject matter expert and as a coding consultant to providers.
• Identifies discrepancies, potential quality of care, and billing issues.
• Timely entry of office and surgical coding charges and assignment of copays and other service payments.
• Works closely with other members of the coding/billing team as well as the other departments within the CBO team.
• Handles special projects as requested.

Certified Professional Coder

• Reviews medical record documentation to abstract and assign diagnoses, procedures, and modifiers for statistical classification and reimbursement purposes.
• Provides feedback regarding documentation and coding issues.
• Utilizes software applications and coding references, including electronic, to perform coding related tasks.
• Maintains an understanding of and ensures compliance with, all applicable coding guidelines.
• Meets or exceeds the minimum coding productivity standard for the type of coding performed.
• Meets or exceeds the minimum coding accuracy rate of 95%.
• Completes required coding training or other assigned coding instruction.
• Participates in departmental coding and educational meetings, trainings, and roundtables.
• Assists in the creation, evaluation, updating and on-going review of Desk Procedures for assigned areas.

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