Under the supervision of the Revenue Cycle Supervisor, responsible for revenue cycle functions including and not limited to coding/edit charge review, accurate timely submission of insurance claims, failed claims/follow‐up resolutions, training, education, research, denial appeals, resolving unpaid medical claims, cash posting, processing billing calls and inquiries and may serve as an intermediary between healthcare providers, clients, patients, and health insurance companies. Adheres to internal coding policies and expectations set forth by management and acts as a trainer and resource: Reviewing clinical documentation to assign appropriate ICD-10, CPT, HCPCS, and other relevant codes; Ensuring that all codes assigned align with the services rendered, diagnoses, and treatments documented in the patient's medical records; Making necessary adjustments to codes in cases where discrepancies or errors are identified; Collaborating with healthcare providers to clarify documentation and coding as needed; Adhering to all applicable coding guidelines, including those provided by the American Health Information Management Association (AHIMA) and the American Academy of Professional Coders (AAPC). Process accurate code assignments for paper and /or electronic claims and required billing data elements prior to charges being processed for payment and revenue reporting, including coding /edit reviews. Ensures all professional aspects of the assignment of diagnostic and procedural coding is carries out in compliance with applicable Medicare, Medicaid and third‐party payer guidelines. Ensures accurate posting from remits to ensure proper work queue routing and required billing data elements to ensure an accurate accounting processed for payment and revenue reporting.

*This position is considered Hybrid, which means that individuals in this position may work both at an approved Offsite location and Onsite at a primary location or multiple locations based on Business Needs.

JOB FUNCTIONS

• Ensure accurate and timely billing and collection of medical claims.
• Conduct chart reviews on documentation and correct coding to ensure compliance with all governmental and contractual obligations.
• Working with Supervisor and the Compliance office, train providers in proper documentation and coding as
  indicated by chart review.
• Performs charge review, claim edits, and ensuring the accurate and timely CPT/ICD coding for all clinical provider charges.
• Process all charges and reviews and clear all coding edits generated by EMR/PM.
• Clears all errors and edits generated by EMR and PM system.
• Perform complex tasks relating to insurance verification, resolution of aging accounts, resolution of patient
  complaints and client customer service.
• Assist with process improvement to maximize patient experience and reimbursement.
• Process insurance payments, reconciling deposits, posting payments and recoupments, and managing patient
  accounts.
• Ensures accurate posting from remits to ensure proper work queue routing and required billing data elements to
  ensure an accurate accounting processed for payment and revenue reporting.
• Answer and resolve patient inquiries from internal and external sources.
• Serve as an intermediary between healthcare providers, patients, health insurance companies and other stakeholders.
• Participate in special projects and complete other duties as assigned

High School Diploma

Required

Bachelor's Degree

Preferred

Work Experience

Required 4 years Minimum of 4 years of experience in medical coding, medical auditing, or billing, in multi-specialty outpatient/professional billing setting.

Preferred 5 years 5+ years’ experience in revenue cycle, medical coding or medical auditing.

Required within six months of hire Certified Coding Specialist (CCS) through governing body AHIMA Upon Hire Required or Certified Coding Specialist ‐ Physician
(CCS‐P) through governing body AHIMA Upon Hire

OR Certified Professional Coder ‐ (CPC) through governing body AAPC
Upon Hire