Medical Billing and Coding

• Completes electronic and manual billing for all patient accounts in a timely manner.
• Performs electronic billing via electronic health record and clearinghouses.
• Demonstrates knowledge of HCFA 1500 billing criteria.
• Demonstrates comprehensive ability and knowledge of electronic claims processing, electronic remittance advice, electronic payment posting, and clearinghouse functions.
• Demonstrates knowledge of CPT-4, ICD-10, usage of modifiers, and HCPCs coding according to all federal and state regulatory guidelines.
• Demonstrates a thorough knowledge and understanding of benefits and/or coverage as indicated by third party payer requirements.
• Demonstrates in depth knowledge of insurance authorizations with relation to medical billing.
• Performs and regularly updates insurance and physician credentialing to ensure timely processing and payment of claims.
• Communicate with work partners to inform of instructions necessary to complete tasks in a timely fashion.
• Promptly corrects and processes rejected, invalid or denied claims.
• Effectively manages accounts receivable and collections for all assigned clients.

Medical Billing Specialist

• Assigns appropriate admit & principal and secondary diagnoses and/or procedure codes
• Accurately Assign DRG/MSDRG/APR-DRG
• Abstracts all data elements necessary to complete UB0 4
• Verifies demographics, corrects account number, charges and service

Coder IV

• Under the direction of the Revenue Cycle Supervisor - Coding the Physician Coding Specialist II monitors and analyzes unresolved third party accounts for multi-specialty group practices.
• Analyzes outstanding insurance accounts on a daily basis and in accordance with established time frames.
• Initiates appropriate and effective telephone and/or written follow-up on the identified accounts.
• Communicates with payors and other internal departments to obtain critical information impacting claim resolution.
• Researches and responds to all inquiries from the customer service department in a prompt, professional manner.
• Reviews and corrects coding edits and denials.
• May code ICD-10 from written documentation and abstract CPT/HCPCS codes.
• May perform computer assisted coding functions.
• Consistently meets department productivity and quality standards.
• Maintains patient/physician confidentiality and effective communication with patients and physicians.
• Provides information and feedback to various personnel within UHPS.

Physician Coding Specialist II

• Determines accurate CPT, HCPCS procedure and professional supply codes and ICD-10-CM diagnosis codes used for billing services provided by physicians and licensed non-physician providers
• Performs activities related to physician practice management and coding to maintain compliance with payer reimbursement policies and Federal health care program requirements
• Provides training and education on coding and compliance issues to physicians, non-physician providers and staff on an ongoing basis
• Interacts with patient care providers regarding billing and documentation policies, procedures, and regulations; obtains clarification of conflicting, ambiguous, or non-specific documentation as well as communication on coding and compliance issues
• Performs audits and analyses of payer denials; provides information on compliance issues arising from audits and formulates recommendations to providers regarding improved documentation practices to avoid future claims denials
• Researches inquiries from providers and patients about fees, reimbursements, and denials
• Monitors data sources to ensure receipt and analysis of all charges
• Updates encounter forms/super bills on an annual basis with respect to diagnostic, procedural and supply code changes
• Attendance, promptness, professionalism, the ability to pay attention to detail, cooperativeness with co-workers and supervisors, and politeness to customers, vendors, and patients
• Other duties or special projects as assigned.

Certified 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

• Responsible for accurately and timely coding of outpatient and professional medical records following established coding, CMS regulations and hospital guidelines.
• Reviews all types of encounters and accurately codes diagnostic and procedural information following coding guidelines and regulations information including, facility specific guidelines and federal regulations.
• Responsible for accurately coding hospital ancillary, ED, same day surgery, observation and/or professional physician services encounters.
• Maintains productivity and quality rate according to established standards.
• Ensures optimal CPT /ASC/APC/APG assessment.
• Understanding and ability to resolve coding specific edits such as CCI, LCD, NCD and MUE.
• Works within UH billing time frames.
• Maintains coding knowledge and skills via written coding resources, clinical information and educational webinars.
• Maintains knowledge of guidelines and regulations affecting the UHHS Coding Department.
• Maintains up to date credentials.
• Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association (AHIMA).
• Participates in educational and informational activities.
• Performs other duties as assigned.
• Complies with all policies and standards.

Outpatient Coding Specialist I

• Analyzes, on a daily basis and in accordance with established time frames, the outstanding insurance accounts.
• Initiates appropriate and effective telephone and/or written follow-up on the identified accounts.
• Communicates with payors and other internal departments as required to obtain critical information that impacts the resolution of both current and future claims.
• Researches and responds to all telephone inquiries from the customer service department, in a prompt, professional manner meeting departmental guidelines.
• Reviews and corrects coding edits and denials.
• May code ICD-10 from written documentation.
• May abstract CPT/HCPCS codes.
• May perform computer assisted coding functions.
• Working knowledge of coding rules and payer guidelines.
• Consistently meets department productivity standards.
• Consistently meets department quality standards.
• Maintains patient/physician confidentiality at all times and maintains effective communication and professional interaction with patients and physicians.
• Provides appropriate information and feedback to various personnel within UHPS.
• Supports and utilizes established departmental guidelines.
• Recommends additional research to other CBO departments.
• Identifies trends with insurance related issues and reports findings to the Team Lead.
• Acts as a role model for professionalism through appropriate conduct and demeanor at all times.
• Interprets written correspondence and either resolves the problem or forwards it to another department for prompt resolution.
• Effectively communicates utilizing the telephone, form letters or internal correspondence to resolve patient inquiries.
• Handles multiple tasks simultaneously.
• Must have an understanding of insurance products and billing requirements to effectively resolve discrepancies in billing statements.
• Performs other related duties as assigned.

• 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

• Accurately coding diagnoses, procedures and other services to ensure medical records and billing are accurate
• Work with providers to ensure documentation is clear and complete and result in accurate coding
• Review all claim edits and correct errors in a timely fashion
• Code for practice and hospital charges for all departments supported by the Professional Billing Office

Coder

• 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

• Own high-impact medical billing and insurance cases end-to-end
• Assess whether procedure, diagnosis, and modifier codes on an EOB are consistent with service described
• Identify coding conflicts and escalate or dispute them with the appropriate party
• Advocate for users by pushing cases forward with persistence
• Communicate clearly with users, setting expectations and sharing progress

Healthcare Advocate, Medical Coding

•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 accurately and timely coding of moderately complex encounters following established coding, CMS regulations and hospital guidelines.
• Accurately codes diagnostic and procedural information following official coding guidelines, facility specific guidelines and federal regulations.
• Reviews moderately complex medical records to identify sequence, code diagnoses and procedures according to established coding, CMS and hospital guidelines.
• Responsible for accurately coding hospital same day surgery, observations, ancillary, ED encounters and/or professional services.
• Ensures optimal CPT, ASC, APC, APG assignment as applicable.
• Understanding and ability to resolve coding specific edits such as CCI, LCD, NCD, and MUE.
• Supports OP Clinical Documentation Improvement program.
• Maintains productivity and quality rate according to established standards.
• Works within UH Billing time frames.
• Maintains coding knowledge and skills via written coding resources, clinical information and educational webinars.
• Maintains knowledge of guidelines and regulations affecting the UHHS Coding Department.
• Maintains up to date credentials.
• Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association (AHIMA).

ProFee Coding Specialist II

• 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

• Examines medical records to determine the proper ICD (diagnosis) and CPT (procedure codes) to be assigned
• Utilizes coding tools & resources to verify the correctness of CPT and ICD codes assigned.
• Abstracts data including providers, injury info, quality measures, and others as needed.
• Maintains knowledge of current trends and practices in coding principles and government regulations through reading materials and/or attendance at educational meetings or seminars.
• Maintains appropriate certification.
• Communicates with coworkers and physicians to resolve and clarify questions and documentation discrepancies.
• Communicates risk management concerns to appropriate parties.
• Completes priority accounts (Holds) daily.
• Refers complex issues to designated work queues.
• Participates in coder specific training and education based on audit metrics and trends.
• Review and analyze content of medical record to accurately assign ICD diagnosis and procedure codes; CPT procedure codes and modifiers according to national coding guidelines, USACS policies and SOPs.
• Answer coding and abstracting questions from coding leadership, compliance, clinicians, etc.
• Maintain coding accuracy rate of ≥ 95%.
• Maintain coding productivity (Milestone based standards) rate of ≥ 95%.
• Maintain minimum of 15 CEUs per quarter either through Nthrive and/or other company sponsored webinars and programs.
• Accurately identify and enter core abstracting elements such as physician and APP attributions.
• Identify documentation trends and topics for education/feedback to physicians and APPs.
• Keep current with coding and industry changes through participation in educational opportunities.
• Thorough understanding of updates from intermediaries, carriers, government agencies, third party payers to ensure proper documentation, coding and compliance.
• Thorough knowledge of coding guidelines, medical terminology, anatomy/physiology, reimbursement schemes, payor specific guidelines.
• Assists with special projects as needed and performs related duties as assigned.

Coding Specialist, EM

• 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

• Translate health care services and procedures into standardized codes on out patient accounts
• Work with Epic work quests to maintain timeliness of coding, billing, and accounts receivable
• Communicate with providers, coders and clinical documentation specialists as needed for comprehensive patient record documentation
• Formulate, monitor and respond to all compliant documentation clarification requests to query the provider for resolution of incomplete documentation

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Medical Billing Specialist

Coder IV

Physician Coding Specialist II

Certified Coder

Coder II – Cardiology

Outpatient Coding Specialist I

Physician Coding Specialist II

Coder II – ENT, Audiology

Medical Billing & Collections Specialist

Coder

Coding Specialist II, PB Coding

Healthcare Advocate, Medical Coding

Medical Billing Insurance Specialist

Inpatient Coder

ProFee Coding Specialist II

Physician Support Coder

Coding Specialist, EM

Facility ED Coder

Complex Coder, Surgical Cardiology

Coder