Overview
Perform duties in the billing division related to all aspects of the revenue cycle to include data entry, denials, patient interaction, patient account research, and insurance follow-up and extracting appropriate CPT and ICD-10 codes.
Responsibilities
- Review H&P and surgeon’s documentation for coding and abstracting of patient encounters, including diagnostic and procedural information, significant reportable elements, and complications.
- Researches and analyzes data needs for reimbursement.
- Analyzes medical records and identifies documentation deficiencies.
- Serves as resource and subject matter expert to other coding staff.
- Reviews and verifies that documentation supports diagnoses, procedures and treatment results.
- Identifies diagnostic and procedural information.
- Audits clinical documentation and coded data to validate documentation supports services rendered for reimbursement and reporting purposes.
- Assigns codes for reimbursements, research and compliance with regulatory requirements utilizing guidelines.
- Follows coding conventions. Serves as coding consultant to care providers.
- Identifies discrepancies, potential quality of care, and billing issues.
- Researches, analyzes, recommends, and facilitates plan of action to correct discrepancies and prevent future coding errors.
- Identifies reportable elements, complications, and other procedures.
- Assists in orienting and training staff.
- Provides ongoing training to staff as needed.
- Create charge encounters by entering CPT and ICD10 codes in the Electronic Health Record (EHR) system.
- Research and resolve insurance denials.
- Process – posting claims and manage/work rejections.
- Review claim and discuss overdue balance with patients.
- Register and Update patient demographics in IDX.
- Calculate patient deductibles and co-insurance payment amount.
- Develop payment plans and make payment arrangements for outstanding balances.
- Assists patients/customers with insurance information and balances.
- Handles special projects as requested.
- Ensures doctor(s) submit notes in a timely manner in order to process claims efficiently.
- Verifies insurance information by calling carrier if applicable.
- Responds to inquiries from patients and researches accounts.
- Must possess the ability and skill to independently work in a team environment.
- Performs other duties as assigned.
Qualifications
1 year experience working with CPT & ICD 10 coding and billing required. Current CPC certification is required, or must obtain within 1 year of employment.
Medical applications software experience, Allscripts/IDX preferred. Experience with linking ICD10 to CPT codes to support medical necessity. Knowledge of payor guidelines. Experienced with using modifiers. Ability to extract a written diagnosis from the medical record to assign an ICD10 code.
Location
US-VA-Norfolk