Medical Billing and Coding

• Billing Data Entry involved which requires 10 key skills
• Compare data with source documents and enter billing information provided
• Research missing or incorrect information
• Verification of insurance information
• Ensure daily/weekly billing activities are completed accurately and timely
• Research and update billing demographic data to ensure prompt payment from insurance
• Communication through phone calls with clients and patients to resolve billing defects

Billing Coordinator I – Healthcare Billing Specialist

• Reviews and interprets medical information, physician treatment plans, course, and outcome to determine appropriate ICD-10 CM/CPT codes for diagnoses and procedures. ( 65%)
• Abstracts data elements to satisfy statistical requests by the hospital, health system, medical staff, etc. and enters all coded/abstracted information into designated system. ( 15%)
• Ensures efficient management of medical information and cash flow as it pertains to the unbilled coding report. ( 10%)
• Keeps informed of the changes/updates in ICD-10 CM/CPT guidelines by attending appropriate training, reviewing coding clinics and other resources and implementing these updates in daily work. ( 5%)
• Performs other duties as assigned or required. (5%)

Coder – Outpatient

• Responsible for reviewing and abstracting inpatient medical records
• Identifying and assigning accurate medical codes for diagnosis, procedures, and services in an inpatient setting
• Ensuring all data elements required for federal or state reporting and billing are collected
• Reviews medical record documentation to identify pertinent diagnosis/procedures for inpatient records
• Queries physicians when code assignments are not straightforward or documentation is inadequate
• Keeps abreast of coding guidelines and reimbursement reporting guidelines
• Effectively assigns ICD-10 codes and DRGs to inpatient records
• Maintains 92% to 95% in ICD-10 and DRG assignment and consistently meets established productivity standards

Senior Certified Inpatient 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

• This position is responsible for auditing physician documentation for appropriate coding compliance and reporting this information back to management
• Assist with medical record review to ensure appropriate compliance
• Review and analyze patient medical records, provider documentation, and treatment regimens
• Assign accurate ICD-10-CM, CPT, and HCPCS Level II codes for oncology-related services
• Ensure compliance with CMS, OIG, and payer-specific guidelines
• Identify documentation deficiencies and collaborate with providers for clarification
• Assist with EMR implementation as requested by management
• Maintain compliance with HIPAA and patient confidentiality standards

Certified Coding Specialist

• Identify opportunities to improve provider documentation and create an education plan tailored to each assigned provider
• Arrange educational sessions with assigned providers aimed at quality of care and documentation improvements
• 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

Medical Coder

• Responsible for the correct application of ICD-10-CM, HCPCS, and CPT codes
• Collaborate with multiple departments regarding the status of coding
• Identify opportunities for improvement and ensure documentation compliance
• Enter and reconcile all medications required for Medicare claim reporting
• Work to achieve performance goals and pursue personal development
• Identify, compile, abstract and code patient data using standard classification systems
• Resolve/clarify codes with conflicting or unclear information
• Maintain health record indexes and storage systems to analyze information
• Compile and maintain patients' medical records for data needs

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, 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

Coder – Outpatient, Part-Time

• 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

• Abstract and assign valid CPT, ICD-9/10, and HCPCS codes
• Identify compliance concerns, trends, and educational opportunities
• Work independently with limited oversight
• Communicate professionally with providers and practice management
• Meet or exceed organizational coding production and quality standards

Coder II, OB/GYN

• 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

• Review medical documentation and assign appropriate codes (ICD-10, HCPCS, CPT).
• Ensure compliance with coding standards, regulations, and company procedures.
• Work independently and effectively communicate with medical professionals.
• Understand Medicare and Commercial Carrier workflows related to daily coding and denial review.
• Participate in coding team meetings and serve as a subject matter expert.

Coder, Provider Practice

• 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

• 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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