Medical Billing and Coding

• 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

• 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

• 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

• Come join us as a Coder I, Professional at SSM Health!
• Play a crucial role in ensuring accurate and timely coding of medical records.
• Responsible for reviewing patient information, assigning appropriate codes, and ensuring compliance with coding guidelines and regulations.
• Manages assigned charge review and coding-related claim edit work queues to ensure timely and accurate charge capture.
• Accurately deciphers charge error reasons and plans follow-up steps.
• Identifies all billable services.
• Reviews all applicable data sources, including but not limited to electronic health records, inpatient admits, discharge and transfer (ADT) reports, operative logs, nursing home visit documentation, procedure reports generated from non-electronic health record systems, etc.
• Identifies need for medical records from outside the organization and follows established procedures to obtain.
• Ensures all coded services meet appropriate Medicare, National Correct Coding Initiative (NCCI) or payer-specific guidelines.
• Consults with physicians/providers as needed to clarify any documentation in the record that is inadequate, ambiguous, or unclear for coding purposes.
• Provides education around documentation improvement for maximum patient care.
• Assists physicians/providers with questions regarding coding and documentation guidelines.
• Provides ongoing feedback based on observations from coding physician/provider documentation.
• Identifies opportunities for education and communicates trends to leaders.
• Reviews and resolves charge sessions that fail charge review edits and claim edits.

Coder I

• Work in collaboration with Ancillary or specialty departments/locations/providers to code, review and release charges in a timely manner.
• Ensure correct coding, billing compliance and complete charge capture
• Collaborate with providers and other departmental staff/leaders on coding or charge capture related questions/topics
• Assign or verify CPT, ICD-10 CM coding and modifiers based upon documentation
• Subject matter expert in one or more specialties and may also cover multiple surgical/medical specialties for abstraction, ambulatory and/or surgical/procedural coding
• Ensure compliance with official coding guidelines

Surgical Coding Specialist III

• Utilize available encoder, grouper software, and other coding resources to determine the appropriate ICD-10-CM, CPT, and/or HCPCS including specialty specific codes and Evaluation and Management (E&M) codes
• Maintain an understanding and apply knowledge of National Correct Coding Initiatives (NCCI), Local Coverage Documents and National Coverage Documents (LCD/NCD) directives, Medically Unlikely Edits (MUEs), and Medicare Teaching Physician Guidelines, applying knowledge of applicable regulatory requirements and institutional guidelines to select appropriate codes and modifiers

Medical Coding Specialist II – Radiology

• Responsible for coding and abstracting inpatient accounts in accordance with coding guidelines.
• Assigns accurate diagnostic and procedure codes according to clinical documentation and official coding guidelines for inpatient hospital accounts.
• Coordinates with the clinical documentation and quality teams to ensure validation of Medicare Severity Diagnosis Related Group (MSDRG), patient safety indicators, and hospital acquired conditions are supported by physician documentation to support appropriate coding.
• Monitors assigned work queues to ensure all records are charged in a timely matter.
• Generates coding queries for clarification regarding physician documentation as needed.
• Stays abreast of all changes in coding conventions and coding updates.
• Performs other duties as assigned.

Coder

• Receive incoming calls from customers regarding patient accounts not limited to statements, billing, claims, denials, and all other reimbursement matters
• Investigate escalated customer billing inquiries and take appropriate action to resolve the account
• Research, resolves, corrects, and prevents invoice discrepancies by active interaction with customers and other appropriate staff/departments
• Routes pending insurance and claims processing matters to appropriate staff for follow up
• Communicate medical insurance coverage benefits (in network / out of network) including out of pocket responsibilities, deductible, and coinsurance
• Answer questions regarding the processing of medical claims including denials by insurance companies for products provided
• Resolve customers' billing complaints by performing activities in the billing cycle not limited to resolving hold accounts, granting adjustments (write-offs), and small balance reviews
• Prepares and sends correspondence to customers related to invoices and payment history when requested
• Collaborates with internal staff to resolve account hold due to bad debt
• Locate and notify customers of delinquent accounts by mail, telephone, or personal visits to solicit payment
• Complete private pay charges for balances owed via checks and credit card payments
• Arrange for debt repayment or establish repayment schedules, based on customers' financial situations
• Performs detailed account reconciliations as needed to resolve complex disputed receivable issues
• Collect on accounts by sending bills or following up on bills with payers via phone, email, fax, mail, or websites
• Utilizes collection techniques to resolve accounts according to company’s policies and procedures
• Ensure organization receives accurate payment for goods provided according to contracted rates and/or payer fee schedules
• Respond to Collection agency regarding patient disputes of balances owed on accounts
• Reconcile the accounts receivable to ensure that all payments are accounted for and properly posted
• Monitors system dashboard related to patient collections
• Creates daily reports from the system for patient collection activity
• Responsible for entering data in an accurate manner, into database including although not limited to payer, authorization requirements and coverage limitations
• Responsible for the daily claims submissions/printing for all eligible/ready status claims
• Monitor patient account details for non-payments, delayed payments, and other irregularities
• Analyze documentation required for billing services and ensure compliance to payer requirements
• Resolve pending revenue by reconciling received documentation and pending charges
• Performs extensive account audits and ensures proper billing for services to the accurate payer
• Ensures proper revenue recognition for billed charges and services moving forward

Medical Billing Services Specialist

• 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

• Utilize available encoder, grouper software, and other coding resources to determine the appropriate ICD-10-CM, CPT, and/or HCPCS including specialty specific codes and Evaluation and Management (E&M) codes.
• Maintain an understanding and apply knowledge of National Correct Coding Initiatives (NCCI), Local Coverage Documents and National Coverage Documents (LCD/NCD) directives, Medically Unlikely Edits (MUEs), and Medicare Teaching Physician Guidelines, applying knowledge of applicable regulatory requirements and institutional guidelines to select appropriate codes and modifiers.

Medical Coding Specialist II – Multi Surgical Specialty, ENT/Plastics

• Utilize available encoder, grouper software, and other coding resources to determine the appropriate ICD-10-CM, CPT, and/or HCPCS including specialty specific codes and Evaluation and Management (E&M) codes
• Maintain an understanding and apply knowledge of National Correct Coding Initiatives (NCCI), Local Coverage Documents and National Coverage Documents (LCD/NCD) directives, Medically Unlikely Edits (MUEs), and Medicare Teaching Physician Guidelines

Medical Coding Specialist II – Multi-Specialty

• Responsible for claims submission and insurance follow up
• Post insurance payments and reconcile accounts
• Research and analyze payments for accuracy
• Resolve coverage and denial issues with patients and insurance companies
• Prepare bank deposits and refund requests
• Maintain professional and confidential communication with all parties

Medical Billing Specialist

• 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

• 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

• Performs Current Procedural Terminology (CPT) and International Classification of Diseases coding through abstraction of the medical record.
• Trains physicians and other staff regarding documentation, billing and coding.
• Performs various administrative and clerical duties to support the role’s core function.
• Ensures charges are captured by performing various reconciliations.

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