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

• Coordinate the identification of potential claim editing & clinical program enhancements for Medicare compliance
• Collaborate and partner with functional leads and other business areas
• Provide support and management of savings opportunities and provider/customer deviation implementation

Health Services, Certified Professional Coder (CPC)

• Ensure 100% charge capture by reviewing physician dictated notes and operative reports and properly code all services performed utilizing appropriate CPT, ICD-10-CM codes and modifiers.
• Daily review of EPIC Charge Review Work queues is essential.
• Monitor and report on accounts receivable issues related to payer compliance and/or billing processes.
• Act as a resource to providers, office staff, administration and the Central Business Office.
• Participation in coding training and education is also required.
• Maintain yearly certification as a Certified Professional Coder is required with the American Academy of Professional Coders.

Senior Billing Liaison, Coder

• 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

• Engages with providers and other internal external stakeholders to ensure proactive collaboration in reviewing coding and documentation guidelines
• Examine medical records and various documentation to ensure the precision of code assignment
• Researches, validates, and stays abreast of coding and billing issues, trends and changes to recommend concepts
• Conducts analyses of claims data to bolster the creation of educational concepts
• Provide providers with comprehensive feedback on current year coding guidelines

Medical Coding Education Associate

• 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 unclear, or unsubstantiated 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)

Outpatient Surgery Coder

• Provides medical coding expertise and consultative support to Independent Practice Association (IPA) affiliates
• Analyzes trends, triages, and answers questions in real-time
• Delivers ongoing education, supports coding workflows
• Conducts quarterly chart reviews for assigned providers
• Supports daily operations of internal coding solutions
• Participates in a daily coder helpdesk providing real-time support to providers

Consultative Coder

• Provides medical coding expertise and consultative support to IPA affiliates nationwide
• Analyzes trends, triages and answers questions in real time
• Delivers ongoing education and supports coding workflows for assigned providers
• Conducts quarterly chart reviews to evaluate coding accuracy
• Participates in daily coder helpdesk providing real-time support for providers

• Execute tasks focused on revenue generation through account resolution for any company client.
• Review documentation to support or contest payer coding decisions for multiple facilities.
• Prepare clear, concise, and well-supported appeals where applicable, using all available documentation, coding guidelines, and regulatory references to defend billed claims and secure reimbursement on insurance accounts receivable.
• Investigate the root causes of denials and downgrades, as needed.
• Provide targeted training on coding practices to Currance team members, promoting accuracy, compliance, and efficiency in resolving coding-related issues.
• Participate in daily shift briefings and contribute actively.
• Resubmit corrected claims according to Federal, State, and payer-mandated guidelines.
• Research, analyze, and correct claim errors and rejections to ensure accurate resubmission and to avoid payer denials due to preventable errors.
• Escalate problematic accounts, recurring issues, or trends to Supervisor and recommend education or denial prevention measures to the client.
• Stay current on payer updates, process changes, and coding guidelines to maintain compliance with Federal, State, and payer requirements.
• Meet productivity standards while maintaining quality output.
• Communicate payer-specific issues to the team and management for timely resolution.
• Engage in continuous learning to remain up to date on coding and payer policies.

Denial Resolution Specialist

• Conducts quality assurance coding of medical records and ICD-10 diagnosis codes
• Assumes ownership and leads advanced and highly specialized administrative/operational/customer support duties
• Ensures coding is accurate and properly supported by clinical documentation within the health record
• Reviews medical records to report conditions that map to HCCs
• Follows state and federal regulations and internal policies
• Works on projects that may include making phone calls to providers
• Participates on special projects, in addition to daily responsibilities

Risk Adjustment Coder

• Ensures high quality documentation that is thorough, accurate and complete to ensure correct reimbursement capture.
• Assigns diagnostic and procedure codes to simple record types up to highly complex record types.
• Organizes and prioritizes assigned work to ensure that work is completed within the assigned time frame.
• Reviews charts and entire medical records, assigning ICD and CPT code combinations to each data element.
• Audits for documentation opportunities and queries clinical staff to fill in any gaps to clarify confusing, incomplete or conflicting information and obtain any needed additional documentation.
• Contacts and works with physicians as needed for clarification of details to ensure correct coding.
• Accurately utilizes the ICD-10-CM classification system and CPT classification system in assigning diagnostic, procedural and complication codes to all claims while meeting billing requirements of various payers.

Coder

• 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

• Accurately assigns diagnosis and procedure codes for inpatient facility and professional services.
• Performs necessary tasks within MHS GENESIS and other military coding systems.
• Accurately assign Evaluation and Management (E&M) codes, ICD-CM diagnoses, CPT and HCPCS, modifiers, and quantities derived from medical record documentation.
• Reviews encounter and/or record documentation to identify and resolve inconsistencies, ambiguities, or discrepancies.
• Assigns accurate codes based on provider responses to coding queries.
• Supports DHA coding compliance by performing due diligence in ethically and appropriately researching and/or interpreting existing guidance.
• Utilizes MHS computer systems to remotely access patient records and assign codes for patient encounters in support of other MTFs.
• Achieve and maintain DHA coding productivity and accuracy standards for the position.
• Educates and provides feedback to providers and clinical staff to resolve documentation issues to support coding compliance.
• Acts as a source of reference to medical staff having questions, issues, or concerns related to coding.
• Responds to provider questions and provides examples of appropriate coding and documentation reference(s).

Medical Coder II

• Responsible for accurate, timely inpatient facility coding supporting the VA Portland Health Care System.
• Reviews medical records for complete documentation, assigns and sequences ICD-10-CM/PCS, CPT/HCPCS, DRG, and related codes via VA systems (VistA/CPRS).

Medical Records Technician – Inpatient Coder

• Responsible for accurate, timely outpatient and/or inpatient facility coding supporting the VA Portland Health Care System.
• Reviews medical records for complete documentation, assigns and sequences ICD-10-CM/PCS, CPT/HCPCS, DRG, and related codes via VA systems (VistA/CPRS).
• Perform outpatient facility coding including ICD-10-CM, ICD-10-PCS, CPT/HCPCS, DRG, and E&M for all encounters assigned by VAPORHCS.
• Access and review health record documentation in VA's VistA/CPRS system; enter codes into the approved coding application.
• Apply modifiers, CCI bundling guidelines, and Reason Not Billable (RNB) designations as appropriate.
• Code all standard cases within 7 calendar days of receipt/discharge; priority cases within one business day.
• Clarify conflicting, ambiguous, or nonspecific record information by consulting with the contract coder supervisor.
• Comply with all HIPAA, VA/VHA privacy, security, and records management directives, and complete all required VA training prior to system access and annually thereafter.
• Comply with AHIMA Standards of Ethical Coding.

Medical Records Technician – Outpatient Coder

• 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

• 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

• 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)

Medical Billing and Coding jobs in Virginia

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Medical Records Coder II – Ophthalmology

Profee Coder – Primary Care

Health Services, Certified Professional Coder (CPC)

Senior Billing Liaison, Coder

Certified Facility Coder

Medical Coding Education Associate

Outpatient Surgery Coder

Consultative Coder

Consultative Coder

Denial Resolution Specialist

Risk Adjustment Coder

Coder

Certified Professional Coder

Inpatient Coder Specialist – Community Facility

Medical Coder II

Medical Records Technician – Inpatient Coder

Medical Records Technician – Outpatient Coder

Medical Records Coder II – Outpatient

Medical Billing Specialist

Coder II