Medical Billing and Coding

• Reviews documentation and assigns appropriate ICD-10, CPT and HCPCS codes.
• Assigns appropriate primary diagnosis after deciding what was chiefly responsible for the encounter.
• Assigns appropriate modifiers according to guidelines.
• Finalizes the appropriate data for accounts.
• Clarifies documentation or diagnosis by communicating with the physician.
• Ensures weekly, monthly, and quarterly department goals are met.
• Makes recommendations to the Billing and Coding Manager for process and quality improvement.
• Maintains knowledge of current coding rules and trends for coding types assigned by attending seminars, workshops and watching webinars.

Medical Coder

• Reviewing documentation and selecting the appropriate procedure and/or diagnosis code to be entered in billing documents
• Ensuring that teaching physician requirements are met and are clearly reflected in the documentation
• Other duties as assigned

Certified Coder – Practice Operations, Certified Professional Coder

• Performing Medical Bill review and investigation of medical invoices
• Analyzing bill for proper assignment of detailed medical coding information
• Interpreting workers compensation rules for repricing
• Entering/correcting data of medical bill information
• Accurate billing per the American Medical Association
• Review of medical documentation to support billing
• Ability to discuss coding to medical providers

Senior Medical Bill Examiner – Coder

• Independently perform complex, specialty-specific professional fee coding (CPT/HCPCS and ICD-10-CM) for physician services rendered in both office and hospital settings
• Ensure all coding adheres strictly to official guidelines (e.g., provided by AAPC or AHIMA), federal regulations (CMS), and organizational compliance standards
• Identify the need for formal clinical queries for documentation clarification when necessary for professional or facility records
• Maintain high accuracy and productivity standards appropriate to the complexity of the assigned workload
• May provide informal guidance to new coding staff on professional coding nuances

Coder II – Cardiology

• Perform prospective medical record reviews for clinical indicators
• Review patient medical records for coding accuracy
• Collaborate with healthcare providers and stakeholders
• Participate in coding education for staff and maintain accuracy standards

Risk Adjustment Coding Specialist I

• Independently perform complex, specialty-specific professional fee coding (CPT/HCPCS and ICD-10-CM) for physician services rendered in both office and hospital settings, ensuring expert application of modifiers and E/M guidelines
• Perform entry-level facility coding for simple outpatient encounters (e.g., diagnostic imaging, labs) and basic inpatient services (e.g., uncomplicated admissions, short stays) using ICD-10-CM and ICD-10-PCS, where applicable
• Ensure all coding adheres strictly to official guidelines (e.g., provided by AAPC or AHIMA), federal regulations (CMS), and organizational compliance standards
• Identify the need for formal clinical queries for documentation clarification when necessary for professional or facility records
• Maintain high accuracy and productivity standards appropriate to the complexity of the assigned workload
• May provide informal guidance to new coding staff on professional coding nuances

Coder II – ENT, Audiology

• 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

Certified Coder – Practice Operations – Part-Time

• Utilizes technical coding expertise to reviews the medical record thoroughly, utilizing all available documentation abstract and code physician professional services and diagnosis codes (including anesthesia encounters, operative room and surgical procedural services, invasive procedures and/or drug infusion encounters).
• Follows Official Guidelines and rules in order to assign appropriate CPT, ICD10 codes and modifiers with a minimum of 95% accuracy.
• Ensures charges are captured by performing various reconciliations (procedure schedules, OR logs and clinical system reports).
• Provides documentation feedback to physicians.
• Maintains coding reference information.
• Trains physicians and other staff regarding documentation, billing and coding.
• Reviews and communicates new or revised billing and coding guidelines and information.
• Attends meetings and educational roundtables, communicates pertinent information to physicians and staff.
• Resolves pre-accounts receivable edits. Identifies repetitive documentation problems as well as system issues.
• Makes appropriate changes to incorrectly billed services, adds missing unbilled services, provides missing data as appropriate, corrects CPT and ICD9 codes and modifiers. Adds MBO tracking codes as needed.
• Collaborate with Patient Accounting, PB Billing, and other operational areas to provide coding reimbursement expertise; helps identify and resolve incorrect claim issues and is responsible for drafting letters in order to coordinate appeals.
• Acts as key point person for Revenue Cycle staff and Account Inquiry Unit staff in obtaining documentation (notes, operative reports, drug treatment plans, etc.). Provides additional code and modifier information to assist with appealing denials. May contact providers for peer-to-peer reviews.
• Meets established minimum coding productivity and quality standards for each encounter type.
• May perform other duties as assigned.

Coding Specialist II, PB Coding

• Codes all outpatient medical records in a timely and accurate manner according to department policy.
• Defines and transforms verbal descriptions of diseases, injuries, and procedures into numerical designations (codes) using ICD-10-CM and CPT-4 according to established coding guidelines.
• Initiates a physician/department query when there is conflicting, incomplete, or ambiguous documentation in the record or additional information is needed for accurate coding.
• Enters all required information accurately into computer system for reimbursement and statistical purposes.
• Remains abreast of all applicable Federal, State, regulatory and hospital-specific coding guidelines.
• Applies applicable guidelines to all cases coded to ensure accuracy of selected codes.
• Accesses and research applicable reference materials to further support decision-making in code selection.
• Mentors less experienced coding personnel.
• Participates in Performance Improvement/Quality Assurance activities.
• Reports on software and hardware problems.
• Attends required educational sessions (webinars, conferences etc.) to maintain and enhance coding certification(s).
• Maintains and Model the Organization’s values.
• Demonstrates regular, reliable and predictable attendance.
• Performs other duties as required.

Certified Coder, Analyst

• Identifies and applies appropriate ICD-10 diagnostic and CPT procedural codes to individual patient health information for claims processing, data retrieval and analysis.
• Responsible for patient financial related activities, which includes accurate entry of insurance benefits, authorizations and other activities which ensures complete and accurate claims.

Surgical Coder

•Analyze, audit and resolve claims outstanding, denied, or incorrectly paid
•Review and respond to payer correspondence.
•Submit appeals as needed for denied claims.
•Contact insurance companies and navigate payer websites in order to secure and expedite insurance payments.
•Resolves patient billing inquiries.
•Document in detail all actions taken in accounts receivable system.
•Meet productivity expectations as outlined by supervisor.
•Recognize, document and notify Team Lead of trends resulting in nonpayment or incorrectly paid claims.
•Answer and resolve inbound calls from insurance carriers.
•Participate in process improvement initiatives as needed.
•Keep current with Medicare and other third party administrators regulations and procedures.
•Manage any special projects requested by supervisor or team lead.
•Must be able to perform the essential functions of this position with or without reasonable accommodation.

Medical Billing Insurance 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

• Responsible for assisting the coding department with the day-to-day non-coding duties support activities
• Assigns codes to office-based visits and procedures using the International Classification of Diseases (ICD-10-CM), Current Procedural Terminology (CPT), and Healthcare Common Procedure Coding System (HCPCS)
• Resolve coding edits to assure accurate and complete claims submission
• Sequences diagnoses and procedure codes as outlined in CPT, ICD-10-CM, and HCPCS Coding Guidelines while adhering to local and national governmental payer guidelines
• Reviews all clinician documentation to support assigned codes in the health information record
• Follows up and obtains clarification of inaccurate documentation as appropriate
• Codes risk adjustable encounters, resolves CRMs, and trends coding denials, as assigned
• Conducts formal coding and documentation reviews, clinician reviews and quality reviews, as assigned
• Assists with coding research functions and education activities
• Creates clinician coding and documentation education based on query trends or ad-hoc requests
• Adheres to the organization and departmental guidelines, policies, and protocols.
• Abides by Standards of Ethical Coding as set forth by the American Health Information Management Association and adheres to official coding guidelines.
• Practices ethical judgment in assigning and sequencing codes for proper insurance reimbursement
• Maintains confidentiality of patient.

Physician Support Coder

• Code medical records utilizing ICD-10-CM and CPT-4 coding conventions.
• Review the medical record to ensure specificity of diagnoses, procedures and appropriate/optimal reimbursement for hospital and/or professional charges.
• Review complex medical records and accurately code primary/secondary diagnoses and procedures using ICD-10-CM and/or CPT coding conventions.
• Coordinate/review the work of designated employees.
• Ensure quality through regular audits.
• Consult and educate physicians on coding practices.

Medical Records Coder II

• 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

• Perform coding and related duties using established billing office policies in an accurate and timely manner.
• Primary contact with physicians, department administrators, hospital and/or clinical department administrators and their support staff and billing staff.
• Coordinates professional service billings for selected clinical departments.
• Assignment or verification of CPT, ICD-10 CM coding and modifiers based upon documentation.
• Resolve edits for electronic charges, following established policies and procedures to ensure that all data elements are applied.
• Monitor charge flow and act as a liaison with managers, department administrators and other billing personnel.
• Identify, report, and resolve coding and reimbursement issues.

Coding Specialist II – Radiation Oncology

• Perform coding and related duties using established billing office policies in an accurate and timely manner.
• Primary contact with physicians, department administrators, hospital and/or clinical department administrators and their support staff and billing staff.
• Coordinates professional service billings for selected clinical departments.
• Assignment or verification of CPT, ICD-10 CM coding and modifiers based upon documentation.
• Resolve edits for electronic charges, following established policies and procedures to ensure that all data elements (claim requirements – CPT, ICD-10 CM, modifiers, provider, billing area, etc.) are applied.
• Monitor charge flow and act as a liaison with managers, department administrators and other billing personnel to assure consistent and accurate change flow.
• Identify, report, and resolve coding and reimbursement issues.
• Develop and maintain all protocols related to their assigned areas.
• Maintain understanding all Teaching Physician and provider documentation policies.
• Actively participate in new provider orientations.

Coding Specialist II – Psychiatry

• Coordination of coding abstracting, statistics and data retrieval functions
• Responsible for equitable distribution of work and timely processing of charts
• Schedules staff in accordance with workflow and workload, troubleshoots problem areas
• Performs ongoing quality monitoring and provides feedback
• Coordinates educational inservices and serves as a resource for coding questions
• Acts as liaison between coding staff and Business Office, Admitting Office and physicians
• Prepares all quality information for review at the ED MD Quality Committee meeting
• Prepares return correspondence to patients and other providers for the ED Medical Director

Lead Coder

• identify opportunities to improve provider documentation and creates an education plan tailored to each assigned provider
• report to the Manager, Medicare Risk Adjustment
• arrange educational sessions with assigned providers aimed at quality of care and documentation improvements
• identify educational needs based on reports
• prepare comprehensive reports and presentations on coding quality trends, risk areas, and educational outcomes using data visualization techniques
• provider onsite education, based on business needs
• collaboration with other market provider facing role
• use data analytics tools to assess coding quality, identify error patterns, and monitor compliance with internal and external standards
• analyze coding audit results and other relevant data to develop data-driven educational materials and interventions
• participate in cross-functional teams to improve documentation, data integrity, and workflow processes

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