Medical Billing and Coding

• The Outpatient Coder is responsible for accurately abstracting data into appropriate client electronic medical record systems, following the Official ICD-10-CM, CPT, and HCPCS Guidelines for Coding, AMA CPT Guidelines, and CMS directives.
• Performs data entry of required abstracted patient information into the client’s information system.
• Queries physicians when appropriate and interacts with Clinical Documentation staff as per account requirements.
• Maintains consistent coding accuracy rate of 95% or better while also meeting productivity standards.
• Assigns appropriate ICD-10-CM, CPT, HCPCS codes and modifiers to facility-based Ancillary, Emergency Department, Observation, and/or Outpatient Surgery Accounts as per designated workflow.
• Abstracts and enters coded data and/or charges for hospital statistical and reporting requirements.
• Queries physicians to clarify conflicting, imprecise, incomplete, ambiguous, and/or inconsistent clinical information when appropriate.
• Communicates documentation improvement opportunities and coding issues to appropriate personnel for follow up and resolution.
• Communicates with Clinical Documentation Improvement and/or Revenue Cycle teams for follow up and reconciliation of accounts.
• Maintains required productivity and quality requirements.

ED Coder – Full-Time/PRN

• The Outpatient Coder is responsible for accurately abstracting data into appropriate client electronic medical record systems
• Assigns appropriate ICD-10-CM, CPT, HCPCS codes and modifiers to facility-based Observation, and/or Outpatient Surgery Accounts as per designated workflow
• Abstracts and enters coded data and/or charges for hospital statistical and reporting requirements
• Queries physicians to clarify conflicting, imprecise, incomplete, ambiguous, and/or inconsistent clinical information when appropriate
• Communicates documentation improvement opportunities and coding issues to appropriate personnel for follow up and resolution
• Communicates with Clinical Documentation Improvement and/or Revenue Cycle teams for follow up and reconciliation of accounts
• Maintains required productivity and quality requirements

Observation Coder, Part Time

• Reviews outpatient clinical documentation and assigns appropriate ICD-10-CM and CPT codes
• Utilizes 3M 360 Finder for code assignment and resolves claim edits
• Monitors outpatient uncoded reports to ensure timely coding and billing process
• Collaborates with physician for clarification as needed
• Reports documentation insufficiencies to the physician
• Updates patient financial accounts in the billing system as required

Coding Specialist

• 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

• 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

• Manage the appeal of unpaid claims in the Central Business Office
• Work closely with insurance carriers in resolving unpaid claims
• Review and appeal unpaid claims daily
• Completes follow-up work on appealed claims
• Works with insurance carriers on appeal issues
• Provides feedback to the coding department with coding errors or updates
• Review remit to ensure accurate payment was received
• Reviews denials for accuracy
• Obtains all necessary information to expedite the appeal process
• Closes and prints daily batch proof
• Makes charge corrections as needed in the practice management system
• Attends continued education programs for coding
• Other duties as assigned

Certified Appeals 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

• Coding Specialists are an important part of the Team at CorroHealth
• The Coding Team Member will provide CPT, HCPCS and ICD-10-CM coding Outpatient Facility Same Day Surgeries
• Must be able to work from home and be independent in their coding skills
• Provide various components of coding services to support our clients
• Calculate ProFee and/or Facility E/M levels by using an algorithm created by our company
• Recognize critical care cases by patient acuity
• Code surgical procedures typical of an ER setting to capture additional revenue when appropriate
• Apply ICD-10-CM diagnosis codes to the highest level of specificity available
• Accurately apply diagnosis and procedure codes utilizing ICD-10-CM, ICD-10-PCS, CPT®, and HCPCS
• Interpret coding guidelines for accurate code assignment
• Identify the importance of documentation on code assignment and the subsequent reimbursement impact
• Align conduct with AHIMA's Standards of Ethical Coding and the Company’s Code of Ethics and Business Conduct and support the Company’s Ethics and Compliance Program
• Comply with all internal policies and procedures
• Actively participate in Company provided training and education

Facility SDS and Observations Coder

• Provide various components of coding services to support our clients
• Calculate ProFee and/or Facility E/M levels by using an algorithm created by our company
• Recognize critical care cases by patient acuity
• Code surgical procedures typical of an ER setting to capture additional revenue when appropriate
• Apply ICD-10-CM diagnosis codes to the highest level of specificity available
• Accurately apply diagnosis and procedure codes utilizing ICD-10-CM, ICD-10-PCS, CPT®, and HCPCS
• Interpret coding guidelines for accurate code assignment
• Identify the importance of documentation on code assignment and the subsequent reimbursement impact
• Align conduct with AHIMA's Standards of Ethical Coding and the Company’s Code of Ethics and Business Conduct
• Comply with all internal policies and procedures
• Actively participate in Company provided training and education
• Ensure individual compliance with all privacy and security rules and regulations

OP Diagnostic Ancillary Coder

• Provide CPT, HCPCS and ICD-10-CM coding Outpatient Facility Emergency Department charts.
• Provide various components of coding services to support our clients.
• Calculate ProFee and/or Facility E/M levels by using an algorithm created by our company.
• Recognize critical care cases by patient acuity.
• Code surgical procedures typical of an ER setting to capture additional revenue when appropriate.
• Apply ICD-10-CM diagnosis codes to the highest level of specificity available.
• Accurately apply diagnosis and procedure codes utilizing ICD-10-CM, ICD-10-PCS, CPT®, and HCPCS.
• Interpret coding guidelines for accurate code assignment.
• Identify the importance of documentation on code assignment and the subsequent reimbursement impact.
• Comply with all internal policies and procedures.

Facility ED Coder

• Provide various components of coding services to support our clients.
• Calculate ProFee and/or Facility E/M levels by using an algorithm created by our company
• Recognize critical care cases by patient acuity.
• Code surgical procedures typical of an ER setting to capture additional revenue when appropriate.
• Apply ICD-10-CM diagnosis codes to the highest level of specificity available.
• Accurately apply diagnosis and procedure codes utilizing ICD-10-CM, ICD-10-PCS, CPT®, and HCPCS
• Interpret coding guidelines for accurate code assignment
• Identify the importance of documentation on code assignment and the subsequent reimbursement impact.
• Ensure individual compliance with all privacy and security rules and regulations and commit to the protection of all Company confidential information, including but not limited to, Personal Health Information

Facility SDS Coder

• 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

• Accurately enter ABS data (e.g. Surgeon name, procedure date, discharge disposition, admit diagnosis, POA status, etc.) 95% + Accuracy
• Meets or exceeds bill drop dates/AR expectations
• Consistently monitors and manages AR to facilitate dropping of pending, old, or problematic accounts of assigned locations in accordance with 30-Day Bill Drop policy.
• Accurately reports principal diagnosis in keeping with the most current AHA Coding Clinic and ICD-10-CM/ICD-10CM guidelines. 95% + Accuracy
• Manages NCCI and OPPS edits in compliance with industry regulations. Appends modifiers to charges when appropriate.
• Identifies and reports to supervisor recurring charge issues that can be addressed with ancillary department managers.
• Generates appropriate query selection based on clinical evidence established in the patient medical record.
• Maintains established Productivity Standards Same Day Surgery: 6 accounts per hour Observation: 5 accounts per hour.
• Emergency Room: 12 accounts per hour. Ancillary encounters: 30 accounts per hour.
• Meets or exceeds the expected DRG/APC accuracy rate of 95% Diagnosis and procedural codes applied to accounts result in the appropriate DRG or APC assignment(s)

Coder II

• Educate and support Providers, Division Directors/Managers and clinical staff by providing ongoing coding training
• Conduct random chart audits and provide direct feedback to providers
• Investigate and answer provider coding questions
• Review various data/reports and provide additional feedback
• Routinely visit Providence Medical Groups (PMG) clinics and attend clinical meetings
• Stay current with annual updates to CPT and ICD-10 and HCPCS codes

Coder

• Codes and abstracts diagnoses and patient information from outpatient ancillary encounters and enters data into the hospital information system
• Verifies abstracted hospital information fields for accuracy and completeness
• Monitors daily data printout to assure completion of all outpatient records requiring coding and abstracting
• Communicates with physicians or physician office staff when documentation is unclear or insufficient to complete the coding process
• Maintains coding proficiency through self-directed continuing education

HIM Coding Specialist I

• Assign appropriate diagnosis codes (ICD-10) and procedure codes (CPT/HCPCS) to patient encounters
• Ensure compliance with coding guidelines, including those outlined by the AMA, CMS, and other regulatory bodies
• Analyze medical records to extract pertinent information for coding purposes
• Maintain a high level of accuracy and quality in coding assignments
• Utilize coding software, encoders, and electronic health record systems
• Support coding compliance efforts by participating in coding audits and internal or external coding reviews
• Maintain accurate records of coding activities

Coding Specialist II

• 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

• Codes and abstracts professional fee hospital services from medical records according to guidelines
• Utilizes 3M Encoder for validation of RVUs and procedure unbundling
• Maintains a 95% coding accuracy rate

Emergency Department Medical Coder – Per Diem

• 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

• 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

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