Medical Billing and Coding

• Coordinate/review the work of subordinate employees and assist with the training and continuing education programs.
• 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.
• Abstract information from medical records following established methods and procedures.
• Review the complex (problematic coding that needs research and reference checking) medical records and accurately code the primary/secondary diagnoses and procedures using ICD-10-CM and/or CPT coding conventions.
• Ensure quality and quantity of work performed through regular audits.
• Assist with research, development, and presentation of continuing education programs in areas of specialization.
• Sequence the diagnoses and procedures using coding guidelines.
• Ensure DRG/APC assignment is accurate.
• Abstract and compile data from medical records for appropriate optimal reimbursement for hospital and/or professional charges.
• Consult with and educate physicians on coding practices and conventions in order to provide detailed coding information.
• Communicate with nursing and ancillary services personnel for needed documentation for accurate coding.
• Maintain a thorough understanding of anatomy and physiology, medical terminology, disease processes, and surgical techniques through participation in continuing education programs to effectively apply ICD-10-CM and CPT-4 coding guidelines to inpatient and outpatient diagnoses and procedures.
• Maintain a thorough understanding of medical record practices, standards, regulations, Joint Commission on Accreditation of Health Organizations (JCAHO), Health Care/Finance Administration (HCFA), Medical Review of North Carolina (MRNC), etc.
• Assist with special projects as required.
• Perform other related duties incidental to the work described herein.

Medical Records Coder II – Ophthalmology

• Evaluates medical records, provides clinical and surgical abstraction and assigns appropriate clinical diagnosis and procedure codes.
• Analyzes medical information from medical records
• Accurately codes diagnostic and procedural information in accordance with national coding guidelines
• Consults with medical providers to clarify missing or inadequate record information and to determine appropriate codes.
• Provides thorough, timely and accurate coding in accordance to department specific productivity and quality standards.

Profee Coder – Primary Care

• Assign and sequence ICD-10-CM, ICD-10-PCS, and CPT-4 codes for inpatient, outpatient, ambulatory, and emergency room records while ensuring accuracy for billing, reimbursement, and compliance
• Review medical records for DRG/APC assignment, verify charge accuracy, abstract clinical data, and collaborate with providers and hospital departments to ensure proper documentation and regulatory compliance
• Accurately reflects the diagnosis and procedures per department procedure within the medical records
• Proactively communicates with providers, staff, leadership and hospital departments to ensure adequate documentation to support services
• Performs Charge capture and data entry per department protocol and procedure
• Ensures accurate abstracting of clinical data and meets regulatory and compliance requirements

Certified Facility Coder

• Utilize technical coding expertise to assign appropriate ICD-10-CM and CPT-4 codes to outpatient visit types.
• Review the medical record thoroughly, utilizing all available documentation to code appropriate diagnoses and procedures.
• Interpret health record documentation using knowledge of anatomy, physiology, clinical disease process, pharmacology, and medical terminology to report appropriate diagnoses and/or procedures.
• Send appropriate physician queries when required for documentation clarification.
• Follow Coding Clinic for HCPCs, CPT Assistant, and interpret coding conventions and instructional notes to select appropriate diagnoses and procedures with a minimum of 95% accuracy.

Outpatient Coder II, HB Coding

• Abstracts and codes physician professional services and diagnosis codes (inpatient admissions, outpatient procedures, diagnostic services)
• Assigns appropriate CPT and ICD9 codes
• Completes coding and billing worksheet
• Ensures charges are captured by performing various reconciliations (procedure schedules, clinical system reports, fatal edit 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
• Resolves pre-accounts receivable edits and monitors reasons for missed billing opportunities

Coding Specialist

• Accurately assigns appropriate ICD-10-CM and CPT-4 codes to outpatient records
• Abstract essential data elements for tracking, reporting, and reimbursement purposes
• Keying, billing and collections for assigned client databases
• Review and analyze medical records for document deficiencies
• Ensure accurate coding and compliance with Federal and State regulations
• Verify accuracy of patient account, type, and demographic data
• Meet productivity standards set by Revenue Integrity Coding department

Certified Professional Coder

• Reviews complex inpatient documentation at a highly skilled and proficient level to assign diagnosis and procedure codes utilizing ICD-10 CM/PCS, CPT, and HCPCS
• Assigns and ensures correct code selection following Official Coding Guidelines and compliance with federal and insurance regulations utilizing an EMR and/or Computer Assisted Coding software
• Responsible for coding high dollar and long length of stay cases for all patient types
• Serves as a subject matter expert to Coding department leaders and peers
• Recommends modifications to current policies and procedures as needed to coincide with government regulations
• Collaborates with the Clinical Documentation Improvement and Quality teams to ensure a match in the DRG and reconciles each Medicare case from a CDI perspective
• Responsible for clinician communication related to disease processes on a clinical level to ensure accurate coding
• Participates in payer audits and meetings by acting as a resource for coding-related audits, as requested

Inpatient Coder Specialist – Community Facility

• Performs the day-to-day billing and follow-up activities within the revenue operations for an assigned Patient Business Services (PBS) location
• Serves as a member of the billing and follow-up team assigned to a PBS location responsible for billing and follow-up of government and non-government accounts
• Provides training and guidance to lower level colleagues and provide problem resolution as needed
• Adheres to proactive practices which includes contacting the payer directly for payment due on accounts and reviewing and responding to all mail correspondence in a timely and accurate manner
• Communicates with appropriate hospital departments to clarify billing discrepancies, and obtain demographic, clinical, financial, and insurance information
• Performs all follow-up functions which includes the investigation of overpayments, underpayments, credit balances and payment delays
• Tasks will be routed to the correct workflows with the objective of maximizing reimbursement for services rendered and ensuring claims are paid or settled in a timely and accurate manner
• Researches claim rejections, make corrections, take corrective actions, and/or refer claims to appropriate colleagues to ensure timely and accurate claim resolution
• Proactively follow up on delayed payments by contacting patients and third-party payers and determining the cause for delay and supplying additional data as required
• May prepare special reports as directed by the Supervisor Billing and Follow-Up to document follow-up services
• Assists in the training and education of Billing and Follow-up Representative I colleagues upon hire and ongoing
• Provides problem resolution to billing and follow-up issues as needed

Billing and Follow-up Representative II – Hospital Medical Billing Follow-up, Medicaid/HMO

• Coordinate/review the work of subordinate employees and assist with the training and continuing education programs.
• Code medical records utilizing ICD-10-CM and CPT-4 coding conventions.
• Review the medical record to assure specificity of diagnoses, procedures, and appropriate/optimal reimbursement for hospital and/or professional charges.
• Abstract information from medical records following established methods and procedures.
• Review the complex medical records and accurately code the primary/secondary diagnoses and procedures using ICD-10-CM and/or CPT coding conventions.
• Ensure quality and quantity of work performed through regular audits.
• Assist with research, development, and presentation of continuing education programs on areas of specialization.
• Maintain a thorough understanding of anatomy and physiology, medical terminology, disease processes, and surgical techniques through participation in continuing education programs.

Medical Records Coder II – Outpatient

• Process and submit medical claims accurately and on time
• Assign appropriate ICD-10, CPT, and HCPCS codes
• Review documentation for coding compliance
• Follow up on denied or unpaid claims as needed
• Communicate with providers, payers, or clients when necessary
• Maintain HIPAA compliance and data security standards

Medical Billing Associate

• Perform day-to-day billing and follow-up activities
• Document claims billed, paid, settled, and follow-up
• Communicate with hospital departments to clarify billing discrepancies
• Investigate overpayments, underpayments, and payment delays
• Proactively follow up on delayed payments

Billing and Follow-Up Representative – Hospital Medical Billing Follow-Up

• Performs the day-to-day billing and follow-up activities within the revenue operations for an assigned Patient Business Services (PBS) location
• Documents claims billed, paid, settled, and follow-up in appropriate system(s)
• Identifies and escalates issues affecting accurate billing and follow-up activities
• Communicates with appropriate hospital departments to clarify billing discrepancies
• Proactively follows up on delayed payments by contacting patients and third-party payers
• Assists in the training and education of Billing and Follow-Up Representative I colleagues.

Billing and Follow-up Representative – PFS, Hospital Medical Billing Follow-up, Medicaid

• Provide expert coding and billing functions for the organization in order to accurately reimburse service delivery
• Conduct Coordination of Benefit audits at external provider agencies

Billing and Coding Specialist

• 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

• Work Remote Position (Pay Range: $19.2123-$28.8184)
• Performs the day-to-day billing and follow-up activities within the revenue operations for an assigned Patient Business Services (PBS) location
• Serves as a member of the billing and follow-up team assigned to a PBS location responsible for billing and follow-up of government and non-government accounts
• Provides training and guidance to lower level colleagues and provide problem resolution as needed
• This position reports directly to a Supervisor Billing & Follow-Up
• Knows, understands, incorporates, and demonstrates the Trinity Health Mission, Vision, and Values in behaviors, practices, and decisions
• Performs daily activities as part of the billing and follow-up team in support of the revenue cycle process for an assigned PBS location
• Documents claims billed, paid, settled, and follow-up in appropriate system(s)
• Identifies and escalates issues affecting accurate billing and follow-up activities
• Adheres to proactive practices which includes contacting the payer directly for payment due on accounts and reviewing and responding to all mail correspondence in a timely and accurate manner
• Communicates with appropriate hospital departments to clarify billing discrepancies, and obtain demographic, clinical, financial, and insurance information
• Performs all follow-up functions which includes the investigation of overpayments, underpayments, credit balances and payment delays
• Tasks will be routed to the correct workflows with the objective of maximizing reimbursement for services rendered and ensuring claims are paid or settled in a timely and accurate manner
• Researches claim rejections, make corrections, take corrective actions, and/or refer claims to appropriate colleagues to ensure timely and accurate claim resolution
• Proactively follow up on delayed payments by contacting patients and third-party payers and determining the cause for delay and supplying additional data as required
• May prepare special reports as directed by the Supervisor Billing and Follow-Up to document follow-up services, e.g., number of claims and dollars billed, claims edited, claims unprocessed, etc
• Assists in the training and education of Billing and Follow-up Representative I colleagues upon hire and ongoing, and as new systems, processes or payers are created
• Provides problem resolution to billing and follow-up issues as needed
• Other duties as needed and assigned by the supervisor

Billing and Follow-up Representative II – Hospital Medical Billing Follow-up Variance

• 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

• Performs the day-to-day billing and follow-up activities within the revenue operations for an assigned Patient Business Services (PBS) location
• Serves as a member of the billing and follow-up team assigned to a PBS location responsible for billing and follow-up of government and non-government accounts
• Provides training and guidance to lower level colleagues and provide problem resolution as needed
• Documents claims billed, paid, settled, and follow-up in appropriate system(s)
• Identifies and escalates issues affecting accurate billing and follow-up activities
• Adheres to proactive practices which includes contacting the payer directly for payment due on accounts and reviewing and responding to all mail correspondence in a timely and accurate manner
• Communicates with appropriate hospital departments to clarify billing discrepancies, and obtain demographic, clinical, financial, and insurance information
• Performs all follow-up functions which includes the investigation of overpayments, underpayments, credit balances and payment delays
• Tasks will be routed to the correct workflows with the objective of maximizing reimbursement for services rendered and ensuring claims are paid or settled in a timely and accurate manner
• Researches claim rejections, make corrections, take corrective actions, and/or refer claims to appropriate colleagues to ensure timely and accurate claim resolution
• Proactively follow up on delayed payments by contacting patients and third-party payers and determining the cause for delay and supplying additional data as required
• May prepare special reports as directed by the Supervisor Billing and Follow-Up to document follow-up services, e.g., number of claims and dollars billed, claims edited, claims unprocessed, etc.
• Assists in the training and education of Billing and Follow-up Representative I colleagues upon hire and ongoing, and as new systems, processes or payers are created
• Provides problem resolution to billing and follow-up issues as needed

Billing and Follow-up Representative II – Hospital Medical Billing Follow-up – Commercial Payors

• 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 and Coding jobs in Missouri

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